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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

13th September 2011, Tuesday

Intensive medical treatment prevents second stroke not intra cranial stenting

Patients at a high risk for a second stroke who received intensive medical treatment had fewer strokes and deaths than patients who received a brain stent in addition to the medical treatment. The investigators published the results in the online first edition of the New England Journal of Medicine.

The National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, funded the trial. The medical regimen included daily blood–thinning medications and aggressive control of blood pressure and cholesterol.

New enrolment in the study was stopped in April because early data showed significantly more strokes and deaths occurred among the stented patients at the 30–day mark compared to the group who received the medical management alone.

In addition to the intensive medical program, half of the patients in the study received an intervention of a self–expanding stent that widens a major artery in the brain and facilitates blood flow. One possible explanation for the higher stroke rate in the stented group is that patients who have had recent stroke symptoms sometimes have unstable plaque in their arteries which the stent could have dislodged, the study authors suggest. The study device, the Gateway–Wingspan intracranial angioplasty and stenting system, is the only system currently approved by the U.S. Food and Drug Administration (FDA) for certain high–risk stroke patients. The study participants were in the highest risk category, with blockage or narrowing of arteries of 70 to 99 percent.

Intensive medical management included a daily dosage of 325 milligrams of aspirin; 75 milligrams a day of Clopidogrel, for 90 days after enrollment; and aggressive management of key stroke risk factors—high blood pressure and high levels of low density lipoprotein (LDL), the unhealthy form of cholesterol. All patients also participated in a lifestyle modification program which focused on quitting smoking, increasing exercise, and controlling diabetes and cholesterol.

"The SAMMPRIS study results have immediate implications for clinical practice. Stroke patients with recent symptoms and intracranial arterial blockage of 70 percent or greater should be treated with aggressive medical therapy alone.

(New England Journal of Medicine, published online September 7, 2011).

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

Intensive medical treatment prevents second
stroke not intra cranial stenting

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Harmony – Interschool Health Festival at MTNL Perfect Health Mela Competitions like model display was organised in the 17th MTNL Perfect Health Mela

Dr K K Aggarwal
    National News

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


19 children dead in Bihar, encephalitis suspected

PATNA: With three more children dying, encephalitis is now suspected to have claimed 19 young lives in Bihar, an official said on Monday even as the state is running short of kits to diagnose the disease. The three children died at Anugrah Narain Medical College and Hospital (ANMCH) in Gaya, about 100 km from here, said a district health official. Sixteen children had earlier died of suspected encephalitis. The children reported high fever, followed by bouts of unconsciousness and convulsions. (Source: TOI, Sep 12, 2011)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

Kids’ cognition may be harmed by fired up cartoons

A few minutes of watching "SpongeBob SquarePants" appeared to have negative effects on executive function in 4–year–olds, researchers reported. In a randomized controlled study, kids who watched the fast–paced cartoon about sea creatures for nine minutes did less well on tests of attention and cognition than those who spent the same amount of time drawing, according to Angeline Lillard, PhD, and Jennifer Peterson of the University of Virginia in Charlottesville. They also did less well than children who watched a more realistic, slower–paced educational cartoon about a pre–school boy, Lillard and Peterson reported online in Pediatrics. (Source: Medpage Today)

For comments and archives

ASNC: Age alone may put symptom-free people at risk for silent ischemia

Traditional risk factors were predictive of silent ischemia in younger individuals, while age seemed to be the main predictor in those ages 74 and up, researchers found. In asymptomatic patients with no prior history of coronary artery disease (CAD), the prevalence of silent ischemia increased with increasing risk factors, Saurabh Malhotra, MD, from Krannert Institute of Cardiology in Indianapolis, and colleagues reported during a poster session here at the American Society of Nuclear Cardiology meeting. However, age, hypertension, diabetes, and smoking only predicted silent ischemia in patients younger than 74. (Source: Medpage Today)

For comments and archives

MBCS: PET–CT imaging points to bone met prognosis

Metabolic activity of bone metastases measured with PET–CT imaging predicted breast cancer patients’ prognosis, researchers found. Higher maximum standardized uptake value on the PET portion of the PET–CT study predicted greater mortality risk in patients with bone metastases (P<0.001 for trend) in the single center study by Komal Jhaveri, MD, of Memorial Sloan–Kettering Cancer Center in New York City, and colleagues. (Source: Medpage Today)

For comments and archives

    Fitness Update

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

Omega–3, heart–health–benefit link questioned: Am J Clin Nutr

Background: n–3 (omega–3) PUFA has been proposed as having health-promoting effects, primarily in relation to ischemic heart disease (IHD). Whether these benefits can be achieved by both a–linolenic acid (ALA, 18:3n–3) and n–3 long–chain PUFA (LC–PUFA) is debatable.

Objective: The objective was to examine the association between ALA intake and risk of IHD in healthy subjects and to see if this was modified by intake of n–3 LC–PUFA or linoleic acid (LA, 18:2 n–6).

Design: This was a prospective cohort study of 3277 healthy Danish women and men free of known IHD.

Results: Four hundred seventy–one cases of IHD were observed during a median follow–up period of 23.3 y. Higher intake of ALA was not significantly associated with decreased risk of IHD among women or men. Although the HR of IHD was stepwise decreased with increasing ALA intake in men (0.84 (95% CI: 0.62, 1.14) in the medium compared with the lowest tertile (reference) and 0.83 (95% CI: 0.56, 1.24) in the highest compared with the lowest tertile), this change was far from significant (P-trend: 0.39). No evidence of effect modification by n–3 LC–PUFA or LA was observed. High n–3 LC–PUFA intake, in comparison with low intake, was inversely associated with risk of IHD; this trend was significant in women (P = 0.04; HR: 0.62; 95% CI: 0.40, 0.97) but not in men (P = 0.15; HR: 0.74; 95% CI: 0.51, 1.06). No associations were observed between intake of LA and risk of IHD.

Conclusion: This study suggests that there is no association between ALA intake and risk of IHD, but a high intake of n–3 LC–PUFA had a significant cardioprotective effect in women.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Stay tuned Padma Shri Awardee Dr KK Aggarwal on Ventilator–associated tracheobronchitis. 12th Sept.mp3: http://bit.ly/psJtJt via@AddThis

@DeepakChopra: #CosmicConsciousness Our life purpose is find our innermost glory and unfold it infinite potential in space and time

    Dr KK Answers

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

Starting enteral nutrition in a patient on ventilator

Starting enteral nutrition with a low infusion rate improves tolerability, compared to initiation at the target rate. A randomized study of 200 mechanically ventilated patients showed that enteral feeding (at the target rate or at 10 mL/hour for six days before being incrementally increased to the target rate) showed no differences in mortality, ventilator–free days, or ICU-free days, but the group that began at the target rate had more episodes of elevated gastric residual volumes and a trend toward more diarrhea. Source: Crit Care Med 2011;39:967.

For comments and archives

    Spiritual Update

One good action neutralizes 20 bad actions

In Mahabharata, we had five Pandavas fighting with hundred Kauravas.
In terms of internal Mahabharata, the hundred Kauravas represents hundred negative tendencies a person can have. In Jainism, they are called ninety nine Atichars.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Is it wrong on the part of an MBBS doctor to present his name as follows? "Dr. ABC, MBBS Physician & Surgeon"?

There is no question of its being wrong. It is a statement of facts. The degree of MBBS is not a single but a double degree, the two degrees being as follows:

  • Bachelor of Medicine
  • Bachelor of Surgery

A person having the two degrees and registered with the Medical Council on the basis of these degrees commits no wrong in holding out as a physician and surgeon.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The Father and His Sons

A father had a family of sons who were perpetually quarreling among themselves. When he failed to heal their disputes by his exhortations, he determined to give them a practical illustration of the evils of disunion; and for this purpose he one day told them to bring him a bundle of sticks.

When they had done so, he placed the faggot into the hands of each of them in succession, and ordered them to break it in pieces. They tried with all their strength, and were not able to do it. He next opened the faggot, took the sticks separately, one by one, and again put them into his sons' hands, upon which they broke them easily.

He then addressed them in these words: "My sons, if you are of one mind, and unite to assist each other, you will be as this faggot, uninjured by all the attempts of your enemies; but if you are divided among yourselves, you will be broken as easily as these sticks."

For comments and archives

    Gastro Update

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

How do you monitor cystic fibrosis liver disease?


Given the challenges in diagnosing cystic fibrosis (CF) liver disease, periodic monitoring for hepatobiliary disease is recommended for all patients with CF. Annual monitoring should include physical examination for liver span, texture, and spleen size, as well as laboratory studies such as complete blood count, liver tests, and fat–soluble vitamin status. Further, because hepatobiliary disease may be a presenting feature in a small percentage of patients, sweat test or mutational analysis should be performed in any patient with undefined liver or biliary disease, even those without overt symptoms of CF.

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist, Max Hospital)

Under the aegis on AOGD

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

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

Day – 1 Interesting Highlights

Key note Address

Landmark lectures by doynes in their respective fields of IVF and endoscopy will be delivered by Mr Yakoub Khalaf and Dr Sheila Mehra.

Evolution of Endoscopic surgery in Infertility in India

Speaker: Dr Sheila Mehra, Senior Consultant, Moolchand Medicity, New Delhi

Recent Advances in ART affecting Clinical Practice in the past 5 years

Speaker: Mr Yakoub Khalaf, Medical Director, ACU, Guys and St Thomas, London

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

For Registration Contact: Address: E –23 Ayurvigyan Nagar New Delhi – 110049

For details contact +91 9871250235

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum calcium

As part of a routine metabolic, electrolyte panel, in persons with kidney, bone, or nerve disease, or when symptoms of significantly increased or decreased calcium concentrations are present.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: An elderly type 2 diabetic patient with cancer lung came with A1c of 7.5%.
Dr Bad: This is high. You need insulin therapy.
Dr Good: This result is ok.
Lesson: As per the 2007 American College of Physicians (ACP) guidelines, A1c goal is >7% for type 2 diabetic patients who are elderly or frail or have a limited lifespan due to comorbid condition.

For comments and archives

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high!
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

For comments and archives

  Quote of the Day

(Dr Chandresh Jardosh)

The first duty of love is to listen. Paul Tillich


It’s anyone’s call: A competition where the outcome is difficult to judge or predict.

  Medicolegal Update

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

What constitute a legal rape?

  • The necessary and required constituents for law to charge a person in offence of rape, is penetration/touching of penis within vulva (leaps of vagina) however slight/little it may be, or even this act may be only for a fraction of second is sufficient to constitute the offence of rape. Neither complete penetration of male genital organ nor rupture of hymen nor complete sexual act or emission of seminal fluid are necessary to amount to rape. Lack of consent is a necessary element in every rape. But this does not mean that a person may make sexual contact with a minor or incapacitated person who actually consented. Lack of consent may result from either forcible compulsion by the perpetrator or incapacity to consent on the part of the victim. Persons who are physically or mentally helpless or who are under a certain age in relation to the perpetrator are deemed legally incapable of consenting to sex. In America, rape or sexual assault is divided into degrees: First–, second–, third–, and fourth–degree sexual assault.
  • West Virginia provides an illustration of how rape laws are typically written. In West Virginia, a person is guilty of sexual assault in the first degree when that person engages in sexual intercourse or sexual intrusion with another person and either inflicts serious bodily injury upon anyone or employs a deadly weapon in the commission of the act. Imprisonment for at least 15 years and not more than 35 years and may be fined from $1,000 to $10,000.
  • The second degree of rape is sexual intrusion with another person without that person’s consent, and the lack of consent results from forcible compulsion means physical force that overcomes such earnest resistance as might reasonably be expected under the circumstances; or threat or intimidation, either express or implied, placing the victim or another person in fear of death, bodily injury, or kidnapping or fear by a person under 16 years of age caused by intimidation by another person who is at least four years older than the victim. The punishment for second–degree sexual assault is imprisonment for at least ten years but not more than 25 years and may include a fine of from $1,000 to $10,000.
  • The Third–degree sexual assault is committed when a person engages in sexual intercourse or sexual intrusion with mentally defective or mentally incapacitated, or when a person age 16 years or older has sex with a person who is less than 16 years old and is at least four years younger than the defendant. Third–degree sexual assault is punishable in West Virginia by at least one, but no more than five, years in prison and may include a fine of not more than $10,000.

(Ref: Bachman, Ronet, and Raymond Paternoster. 1993. A Contemporary Look at the Effects of Rape Law Reform: How Far Have We Really Come? Journal of Criminal Law and Criminology).

For comments and archives

    Mind Teaser

Read this…………………

Helicobacter pylori (H. pylori) is a known cause of peptic ulcer disease. It was discovered in Australia in 1987. Which of the following statements is not true regarding H. pylori.

a) Its infectivity is highest in developed world.
b) Person to person transmission is common
c) It is seen in populations with low socioeconomic status
d) H. pylori is a gram negative microaerophilic bacteria

Yesterday’s Mind Teaser: The carpal tunnel contains all of the following important structures except:

1. Median nerve
2. Flexor pollicis longus
3. Flexor carpi radialis
4. Flexor digitorum superficialis

Answer for Yesterday’s Mind Teaser: 3. Flexor carpi radialis

Correct answers received from: Dr (Maj. Gen.) Anil Bairaria, Dr YJ Vasavada, Dr Shashi Saini,
Dr Valluri Ramarao, Dr Ragavan Moudgalya, Dr Chandresh Jardosh, Dr Madhu Sinha, Dr Suresh kumar,
Dr Neelam Nath, Dr Jainendra Upadilla.

Answer for 10th September Mind Teaser: d. Virus–like particle vaccine
Correct answers received from: Dr Dinesh Yadav, Dr Anurag julka, Dr A K Kela, Dr Rawat Purushottam Singh, Dr Ragavan Moudgalya.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. Chandresh Jardosh)

Government’s Efficiency

Once upon a time the government had a vast scrap yard in the middle of a desert. Government said, "Someone may steal from it at night." So they created a night watchman position and hired a person for the job.

Then Government said, "How does the watchman do his job without instruction?" So they created a planning department and hired two people, one person to write the instructions, and one person to do time studies.

Then Government said, "How will we know the night watchman is doing the tasks correctly?" So they created a Quality Control department and hired two people. One to do the studies and one to write the reports.

Then Government said, "How are these people going to get paid?" So they created the following positions, a time keeper, and a payroll officer, then hired two people.

Then Government said, "Who will be accountable for all of these people?" So they created an administrative section and hired three people, an Administrative Officer, Assistant Administrative Officer, and a Legal Secretary.

Then Government said," We have had this command in operation for one year and we are $18,000 over budget, we must cutback overall cost." So they laid off the night watchman.

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Olopatadine HCl Nasal Spray 0.6% w/w (Additional Indication)
For the relief of the symptoms of seasonal allergic rhinitis in patients 6 years of age and older.
    Public Forum

(Press Release for use by the newspapers)

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

Harmony – Interschool Health Festival at MTNL Perfect Health Mela

The 18th ‘Harmony’, an interschool health festival will be organized on Wednesday, 19th October, 2011 at MTNL Perfect Health Mela to be held at NDMC Grounds Laxmibai Nagar, New Delhi. Over 2000 school children from NCR will be participating in the event.

The festival will be organized by Heart Care Foundation of India, Department of Health, Government of Delhi, NDMC, MCD and World Fellowship of Religions.

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President of Heart Care Foundation of India and MTNL Perfect Health Mela said that education of school children should include health issues.

Competitions like debate, model display, slogan writing, role play, dance, yoga etc will be organized on the spot.

The theme this year will be Science behind Rituals.

School children can change the scenario. Delhi Government’s Dengue Campaign is an example which has been successful with the involvement of school children. Subjects like science behind rituals are important issues which need to be taught at school levels. Most lifestyle disorders start in childhood and adolescence and therefore lifestyle prevention should also be taught at school level.

For comments and archives

    Birthday Wishes
  1. Dear Dr Bajaj, I read your message in Reader’s Response and feel sorry that you may not be aware of the kind of coverup operation which starts in various hospitals once the mass casualties are brought after any disaster. If you want to see the facts for yourself go to the hospital where casualties are taken when disaster strikes next and offer your voluntary service with the proof of you being a doctor – you will get the rude response of not being needed despite severe staff shortage due to obvious high workload – the reason being simple that the incapacitated systems do not want people outside to know the harsh facts about severe gaps to handle such situations and the people who know and work in that system fear to open their mouths else they may lose their jobs……………the cycle goes on… be it Bihar floods, Mumbai bomb blasts and further. We all are helpless and only an Anna can do something who unfortunately is still not around in our medical field. Dr Vivek Chhabra
  2. Dr Sundeep Nigam: Can we give photocopies of patient’s case sheet to a third person on demand under RTI?

    Dr KK Answers: No. Only to an authorized person as per law.
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


18th MTNL Perfect Health Mela

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


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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 Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta