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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; 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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

15th April 2013, Monday

Betel nut chewing can cause neck and head cancer

  • Head and neck cancer accounts for more than 550,000 cases annually worldwide.
  • There is 5- to 25-fold increased risk of head and neck cancer in heavy cigarette smokers.
  • There is a significant increase in risk associated with pipe and cigar smoking as well.
  • Alcohol consumption significantly increases the risk of cancer in the upper aerodigestive tract.
  • Epstein Barr virus (EBV) is the primary etiologic agent in the pathogenesis of nasopharyngeal carcinoma.
  • Human papillomavirus (HPV) is implicated as a primary cause of oropharyngeal cancer.
  • Betel nut chewing is an independent risk factor for the development of squamous cell head and neck cancer. The effects are synergistic with tobacco and alcohol. Betel nut chewing is also implicated in the development of hepatocellular and esophageal cancer.
  • Some dietary factors have a role in protecting individuals from head and neck cancer. There is a protective effect associated with increased consumption of fruits and vegetables. Risk of nasopharyngeal carcinoma is increased in frequent consumers of preserved meats that contain high levels of added nitrites.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Obesity reduces life expectancy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

WHO Day Celebrated

Over 11459 people trained in Hands Only Cardiopulmonary Resuscitation (CPR 10) in one day

Dr K K Aggarwal
    National News

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

Merge traditional with modern

Recommending the need for integrating alternate and modern systems of medicine in India, an official report has asked the government to formulate standard responses and guidelines for critical areas where a combination of therapies can be used for treating patients. It has asked the government to extend the Drugs and Cosmetics Act, 1940, to practitioners of alternate systems of medicine to enable them to prescribe modern medicines and deal with emergency situations. The recommendations also include strengthening postgraduate education both quantitatively and qualitatively and encouraging rigorous and independent research, the quality of which needs to be judged by publications in reputed journals — something that continues to be ignored (with a few exceptions.). A joint Indian Council of Medical Research-AYUSH decision-making body with representation of all research councils should be constituted for promoting interdisciplinary research, it says. “There is a need for independent surveys on the utilisation patterns of the alternate systems of medicine (ayurveda, yoga, unani, siddha and homoeopathy),” an official report on “Status of Indian Medicine and Folk Healing — with a focus on integration of AYUSH medical systems in health care delivery” suggests. India is the only country in the world which officially recognises multiple systems of medicine.

Prepared by the former Health and Family Welfare Secretary (Department of AYUSH), Shailaja Chandra, the report recommends the need for measuring the contribution of contractual AYUSH doctors when they perform AYUSH and modern medicine functions which is quite widespread. Recognising the ground realities where AYUSH doctors recruited under National Rural Health Mission (NRHM) are quite often functioning as the sole in-charge of Primary Health Centres, particularly in remote areas, the emphasis in the report is on equipping them properly if they are expected to provide primary level acute and emergency care. However, the fact that they have been primarily recruited to provide AYUSH health care services has also been underscored.

A Task Force should be set up to address the ground realities relating to patients’ combined use of modern medicine and AYUSH drugs and therapies. Only the government can set up an expert group which can examine whether cases of adverse drug reaction or contraindications call for a cautionary to be issued. The group should have on it pharmacologists who have been working with the AYUSH sector as well as practitioners from ayurveda and unani medicine, who can describe the constituents of the drugs.

Guidelines need to be drawn in consultation with experts from all drug-based AYUSH systems to guide patients about the benefits and strengths available under each system of medicine, the report says.

Modern medicine doctors in the government health facilities also need to be provided with standard literature so that patients can gain basic information about options available without the doctor himself having to get involved. Apart from the doctors, the nursing and pharmacy staff working at the primary and secondary hospitals also need to be exposed to the strengths of the AYUSH systems. The introduction of short orientation modules on AYUSH in the nursing and pharmacy courses needs to be facilitated by the Department of AYUSH by holding discussions with the Nursing and Pharmacy Councils and degree/diploma granting bodies. This should be done through the Para-medical Services Division in the Union Ministry of Health to see that the strategy is followed systematically, Ms. Chandra says in her report.

As a long-term measure, a 10-year integrated MBBS/MD/PhD in integrative medicine needs to be introduced, wherein the essentials of all major healthcare systems can be incorporated. If this is linked with openings for research, it would generate much greater interest in the AYUSH systems. In addition to strengthening AYUSH systems, the report says there is a need for greater refinement in the overall administration of Panchakarma therapies before eventually moving to the establishment of a Centre for Scientific Research in Panchakarma (CSRP) to undertake joint research, the report says. (Source: The Hindu, April 11, 2013)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Types of child neglect

  • Physical neglect is failure to provide adequate food, cloth, shelter, hygiene, protection and safety.
  • Emotional neglect is failure to provide love, affection, security and emotional support.
  • Educational neglect is failure to enroll the child in school.
  • Medical neglect is refusal to seek or delay in seeking medical care when required.

For comments and archives

    Valvular Heart Disease Update

What is transcatheter aortic valve replacement?

Transcatheter aortic valve replacement is a potential option for patients with severe symptomatic aortic stenosis who are considered inoperable for surgical aortic valve replacement.

(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)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Mutation status may guide treatment for HER2 breast cancer

The effectiveness of trastuzumab emtansine (Kadcyla, Genentech), which was recently approved for the second-line treatment of metastatic HER2-positive breast cancer, is apparently not diminished by tumor mutations in the PIK3CA gene. (Source: Medscape)

For comments and archives

Too many alarms dim response

Hospitals -- especially intensive care units -- have too many beeps -- a fact that is leading to "alarm fatigue," which may lead clinicians to ignore important alarm signals, according to an alert issued by the Joint Commission. About 85% to 90% of the thousands of daily alarm signals do not require a clinical intervention, according to the alert. (Source: Medpage Today)

For comments and archives

Adverse drug events found by mining clinical notes in HER

Mining unstructured clinical notes written in electronic health records (EHRs) can be used as a strategy to identify early signs of adverse drug events, according to the findings of a new study by Paea LePendu, PhD, and colleagues from Stanford University in California. The authors published their findings online April 10 in Clinical Pharmacology and Therapeutics. (Source: Medscape)

For comments and archives

Enlarged heart no excuse for inactivity

Patients with hypertrophic cardiomyopathy (HCM) may unnecessarily place restrictions on their physical activity, a survey suggested. (Source: Medpage Today)

For comments and archives

Urology group endorses live surgical events, with guidelines

The operating rooms at San Raffaele Hospital in Milan, Italy went "live" for a few days, broadcasting in real time 22 prostatectomies and other genitourinary surgeries to packed auditoriums here at the European Association of Urology (EAU) 28th Annual Congress. Instead of the hospital's regular surgical teams, patients were treated by celebrity surgeons with high-tech top-of-the line instruments that were flown in for the broadcast. Live conversation took place between the surgeons in the operating rooms and congress delegates in the auditorium. Medical equipment companies promoted the sessions that showcased their latest devices. An official EAU policy endorsing such events was announced on the last day of the congress. (Source: Medscape)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Rules for Heathy Living http://www.prevention.com/mind-body/natural-remedies/healthy-living-rules-deepak-chopra?cm_mmc=Twitter-_-Prevention-_-News-_-DeepakChopra …

@DrKKAggarwal: Should Ram be pronounced as Rama? Dr K K Aggarwal Ever since the British ruled in India, our Hindi and (cont) http://tl.gd/n_1rjnvpc

    Spiritual Update

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

On 3rd Navratri Control Your Fire

Chadraghanta is worshipped on the third day of Navratri. SHE is shown with golden skin and riding a tiger. She is depicted with ten hands and 3 eyes with a crescent moon on the head.

Eight of HER hands display weapons. The rest two are in the mudras or gestures of boon giving and stopping harm (Varada and abhay mudra) indicating protection.

For comments and archives

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

What are the symptoms of intrauterine adhesions?

Women with intrauterine adhesions may experience menstrual dysfunction in the form of absent, light, or infrequent menstruation. Also, they may be unable to achieve pregnancy or may experience recurrent miscarriages. Less commonly, pelvic pain or dysmenorrhea (painful menstrual periods) may be present if the adhesions block menstrual blood flow.

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

The basics of blood


  • Controlled by genes at unknown number of chromosomal loci.
  • Appear by 40 days of intrauterine life- unchanged till death.
  • Also present in tissues and tissue fluids.
    • Blood group system: A group of antigens controlled by a locus having a variable no of allele genes. More than 15 blood group systems are recognized: ABO, Rh, Kell, Duffy, MN, P, Lewis, Lutheran, Xg, Li, Yt, Dombrock, Colton, Public antigens & Private antigens.
  • Blood type- means individual antigen phenotype which is the serological expression of the inherited genes
  • Most of these blood group antigens have been found to be associated with hemolytic disease.
  • However, ABO and Rh account for 98%.

For comments and archives

    An Inspirational Story

A story of tomatoes

An unemployed man goes to try for a job with Microsoft as a cleaner. The manager there arranges for an aptitude test (Section: Floors, sweeping and cleaning).

After the test, the manager says: You will be appointed on the scale of $30 per day, let me have your e-mail address, so that I can send a form to complete and advise you where to report for work on your first day.

Taken aback, the unemployed man protests that he is neither in possession of a computer nor of an e-mail address.

To this the MS manager replies: Well, then, that really means that you virtually don't exist and can therefore hardly expect to be employed. Stunned, the man leaves.

Not knowing where to turn and only having about $10 left, he decides to buy a 10kg box of tomatoes at the supermarket.

Within less than 2 hours, he sells the tomatoes singly at 100% profit. Repeating the process several times more that day, he ends up with almost $100 before going to sleep that night. And thus it dawns on the man that he could quite easily make a living selling tomatoes. Getting up early and earlier every day and going to bed late and later, he multiplies his hoard of profits in quite a short time.

Not too long thereafter, he acquires a cart to transport several dozen boxes of tomatoes, only to have to trade it in again shortly afterwards on a pick-up truck.

By the end of the second year, he is the owner of a fleet of pick-up trucks and manages a staff of a hundred former unemployed people, all selling tomatoes.

Considering the future of his wife and children, he decides to buy some life assurance.

Calling an insurance adviser, he picks an insurance plan to fit his new circumstances. At the end of the telephone conversation, the adviser asks him for his e-mail address in order that he might forward the documentation.

When the man replies that he has no e-mail, the adviser is stunned: "What, you don't even have e-mail? How on earth have you managed to amass such wealth without the Internet, e-mail and e-commerce? Just imagine where you would have been by now, if you had been connected from the very start!"

After a moment's silence, the tomato millionaire replied: "Sure! I would have been a cleaner at Microsoft!"

Morals of the story

  • The Internet, e-mail and e-commerce do not need to rule your life.
  • If you don't have e-mail, but work hard, you can still become a millionaire.
  • Seeing that you got this story via e-mail, you're probably closer to becoming a cleaner than you are to becoming a millionaire.
  • If you do have a computer and e-mail, you're already being taken to the cleaners by Microsoft.

For comments and archives

  Cardiology eMedinewS

Lost pregnancies linked to long QT mutations Read More

  Pediatric eMedinewS

Timing of infant corneal transplantation complex 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)

If a person is on antimalarials or steroids or taking immunosuppressant drug, what is the schedule?

The vaccine on Day 0 (first injection) must be doubled and given at two sites (deltoids or thigh in young children). In category II exposures, it is recommended to administer even RIGs along with vaccine. Rest of the schedule is same as for any other patient.

    IJCP Special

Dr Good Dr Bad

Situation: A female smoker wanted to know her risk of diabetes.
Dr. Bad: There is no risk.
Dr. Good: You are at high risk.
Lesson: A study published in the journal ‘Diabetes Care’ has shown that females who smoke more than 20 cigarettes daily have higher chances of developing type 2 diabetes.

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy. Gingival hyperplasia is a known side effect of amlodipine.

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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  Quote of the Day (Dr GM Singh)

True genius sees with the eyes of a child and thinks with the brain of a genie. Puzant Kevork Thomajan

    Mind Teaser

Read this…………………

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, nurse Ernie detects dry mucous membranes and lethargy. What other finding suggests a fluid volume deficit?

a. A sunken fontanel
b. Decreased pulse rate
c. Increased blood pressure
d. Low urine specific gravity

Yesterday’s Mind Teaser: When developing a postoperative plan of care for an infant scheduled for cleft lip repair, nurse Elaine should assign highest priority to which intervention?

a. Comforting the child as quickly as possible
b. Maintaining the child in a prone position
c. Restraining the child’s arms at all times, using elbow restraints
d. Avoiding disturbing any crusts that form on the suture line

Answer for Yesterday’s  Mind Teaser: a. Comforting the child as quickly as possible

Correct answers received from: Dr. B.B. Gupta, Dr Kanta jain,Dr Pankaj Agarwal, DR AYYAVOO, Dr pawan Mehta, Dr Santha kumari, Dr.Chandresh Jardosh, Dr Valluriramarao, drjella, Dr. Thakor Hitendrsinh G, Deepali Chatterjee

Answer for 13th April Mind Teaser: Guided imagery

Correct answers received from: Tukaram Pagad

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

The parrot and the magician

A magician worked on a cruise ship. The audience was different each week, so the magician did the same tricks over and over again.

There was one problem. The captain's parrot saw the shows each week and began to understand how the magician did every trick.

Once he understood, he started shouting in the middle of the show, "Look, it's not the same hat!" or, "Look, he's hiding the flowers under the table," or "Hey, why are all the cards the ace of spades?"

The magician was furious, but couldn't do anything. It was, after all, the captain's parrot. Then the ship sank. The magician found himself on a piece of wood in the middle of the sea with, as fate would have it, the parrot.

They stared at each other with hatred, but did not utter a word. This went on for a day and then another and then another.

Finally on the fourth day, the parrot could not hold back and said, "OK, I give up. Where's the ship?"

    Medicolegal Update

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

Preparation of MLC in injury cases

  • The injuries produced by a blunt weapon on tense skin covering the bones, as on scalp, eyebrow, iliac crest, shin, perineum, knee or elbow look like incised wounds
  • While preparing the MLC report, the doctor should keep in mind that he has to provide clues about the weapon used (sharp-edged or otherwise), the direction of the force, the duration of injury, and the location of the wound which may suggest mode of production i.e. suicide, accident, homicides along with whether the injury is fabricated or otherwise
  • The wounds produced by a blunt weapon or by a fall on the hard surface, object, on tense structures/skin covering the bones, such as the scalp, eyebrow, iliac crest, shin, perineum, knee or elbow when the limb is flexed look like incised wound. But lacerated wounds, also called split lacerations, are caused by blunt force and create confusion in the mind of doctor, public and police official about sharp weapon.
  • When the incised looking wounds are examined by doctor under magnifying lens, the edges of such wounds are found to be irregular with bruising and wounds are produced by blunt weapon.
  • Neatly incised laceration is considered as incised wound and broken glass as dangerous weapon.
  • An incised wound, cut, slash, and slice is a clean cut through the skin may or may not underlying tissues and structures caused by sharp edged instruments, which is longer than the depth of wound. It is produced by infliction of an object having a sharp cutting edge such as knife, razor, blade, scalpel, sword over the body.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Besan or gram flour has health benefits

If you are in doubt that your food may be the cause of your illness, try substituting one food each day. To begin with, its best to use foods prepared from besan (gram flour) in place of wheat flour foods said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

People suffering from celiac disease cannot digest a protein called gluten, which is found in barley and wheat flour. This gluten triggers immune system in patients to damage small intestine villi. As a result, patient cannot absorb nutrients from food and remains malnourished which could lead to anemia, weight loss and fatigue. Celiac disease patients suffer from fat malabsorption.

A gluten-free diet is also recommended for patients with wheat allergy, dermatitis herpetiformis; multiple sclerosis, autoimmune disorders, autism spectrum disorders, ADHD, and some behavioral problems.

Gluten-containing cereals are wheat, barley, rye, oats and triticale. Gluten is also present as a food additive in the form of a flavoring, stablizing or thickening agent.

In these conditions one should switch over to gluten free foods. The best alternative is to shift from wheat flour to gram flour (besan).

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 44488 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 Sir, Thanks for providing useful information. Regards: Dr Tapan
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