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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

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eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

19th March 2013, Tuesday

Food- and water-borne diseases in the summer

  1. Summer is the season for typhoid, jaundice and diarrhea.
  2. The main reasons are scarcity of water and poor food, water and hand hygiene.
  3. In summer, the requirement of water increases by 500 ml in adults due to excessive sweating.
  4. For food hygiene, remember the formula ‘heat it, boil it, cook it, peel it or forget it’.
  5. Any food or liquid, if heated before use, cannot cause infection.
  6. Any liquid or water, if boiled before use, cannot cause infection.
  7. Any fruit, which can be peeled by hands, for example, banana and orange cannot cause infection.
  8. Do not use ice prepared from unsterilized water.
  9. Do not take cut fruits and vegetables that have been left open.
  10. Do not drink sugarcane juice sold on the roadsides.
  11. Do not drink water in unwashed glass on the roadside.
  12. Do not eat food that has been leftover for more than 2 hours at room temperature.
  13. Do not eat cucumbers, carrots, watermelon etc. that is sold on the roadsides as chaat unless hygienic.

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

AHA - ACS update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, was organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions.

Dr K K Aggarwal
    National News

Hypothyroidism cases rise among city kids

Chennai: After researchers attached to the Indian Council of Medical Research’s (ICMR) found that 1 in 900 kids in the city were born with hypothyroidism, the call for newborn screening (NBS) has become louder. This is particularly alarming given than the global incidence is 1 in 2,500 children. Releasing the results of the data collected from Chennai, principal investigator Dr S Suresh said, “This has only emboldened us to say that NBS has to be made mandatory, because conditions such as these, if detected, can be treated and the child can have an almost-normal life.” Other cities where the study was conducted are Delhi, Mumbai, Hyderabad and Bangalore. The other disease that was screened for is congenital adrenal hyperplasia, which was found in 1 in 2,000 children, as opposed to a global standard of 1 in 4,500. In Chennai, among 30,514 samples that were screened, 37 babies were confirmed with hypothyroidism and treatment was started. All the samples were taken from the Institute of Obstetrics and Gynaecology of MMC. Hypothyroidism is a treatable condition which can do irreversible damage to the growing brain of the infant. It can cause developmental delay and mental retardation. Congenital Adrenal Hyperplasia is a potentially lethal disorder which may cost the lives of babies, more so male babies. Dr S S Agarwal, who leads the taskforce as chairman, said, “Now that we have exact numbers, we must do more research to find out why it is so high — whether it is region specific or environmental or genetic.” There were a few more diseases that needed to be added to the group of diseases for which mandatory NBS should be done, Dr Suresh said: “The cost for doing tests to detect five disorders that can be treated is about `1,200, but the fact is that very few people opt for it. This is something that our study will urge the government to look into.” (Source: Express News Service, 16th March 2013)

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)


The Medico-Legal Report should be submitted to the Investigating Officer within 48-72 hours of conducting the examination.

    Valvular Heart Disease Update

What are the most common causes of significant mitral regurgitation in the elderly?

The causes are mitral valve prolapse and ischemic heart disease. Surgery for severe chronic mitral regurgitation is recommended for young asymptomatic patients with early evidence of left ventricular dysfunction but the same is not indicated in patients over age 80 to proceed with surgery unless symptomatic.

(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)

Vein surgery for MS fails in first controlled trial

Outcomes in multiple sclerosis patients were not improved with a controversial surgical procedure -- percutaneous transluminal venous angioplasty -- to improve blood flow in cerebrospinal veins, results of a small, double-blind, controlled trial indicated. (Source: Medpage Today)

Wrist PCI viable in unstable shock

Radial artery approach was safe in patients with cardiogenic shock undergoing percutaneous coronary intervention (PCI), and was associated with a reduced mortality compared with transfemoral access, a single-center study found. (Source: Medpage Today)

Deoxycholic acid may reduce submental fat

Deoxycholic acid (ATX-101, Kythera Biopharmaceuticals) improves the appearance of unwanted fat under the chin, results of an open-label phase 3 clinical trial suggest. (Source: Medscape)

Oral desmopressin safe and effective against nocturia

Desmopressin in an orally disintegrating tablet formulation is effective in both women and men with nocturia, according to two studies published online February 20th in the Journal of Urology. (Source: Medscape)

Antioxidant supplements don't affect intraocular pressure

A large epidemiological study is the first to report that high-dose supplements have no effect on intraocular pressure, the major risk factor for glaucoma (American Glaucoma Society (AGS) 23rd Annual Meeting). (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: People gain 6-8 pounds of weight after quitting smoking http://bit.ly/YJPhZE #Health

@DrKKAggarwal: Why do we not hear about more methods of dealing with stress? Please read my #askdeepak reply http://tinyurl.com/buwsrng

    Spiritual Update

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

What are the Vedic principles behind cognitive behavior therapy?

What is counseling?

A: The mental process involves generation of a thought or idea which is analyzed and then acted upon. Thought, analysis and action therefore are the primary three process of human mind. Counseling involves action at all three levels.

For Comments and archives…

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

How do multiple pregnancies affect the mother and the babies?

Multiple gestations are risky for the babies. Because there are too many babies in the womb, you may have a miscarriage. Or you could have a premature delivery when the babies may be born too early (but after 20 weeks of pregnancy) and have problems with lungs, stomach, or intestinal tract. They may have bleeding in the brain, which can cause problems with the baby’s brain, nervous system, and hamper its development. One of the more common problems is cerebral palsy, a condition that affects movement. The mother might have health problems, too. Your blood pressure may get too high (called pre–eclampsia, pregnancy-induced hypertension, or toxemia) and you may develop diabetes (high blood sugar).

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

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

ABO system

The fetal immunoglobulin production is low, so the plasma contains very little of anti-A and B agglutinins.

    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 wave of years collapses 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

Green tea or coffee may reduce stroke risk Read More

STREAM Trial: Treatment with tenecteplase before hospital transfer benefits some Read More

   Pedia News

Ultrasound guides central line placement in children Read More

Bronchiolitis care with home oxygen proves safe, cost-effective
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)

Can the animal bite wounds be cauterized?

Cauterizing the wound is not advisable as it leaves a very bad scar and also does not confer any additional advantage over washing the wound with water and soap. It amounts to malpractice and the doctor can be sued for compensation under COPRA.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with burns came with severe pain.
Dr Bad: It is bad sign.
Dr Good: It is a good sign.
Lesson: Pain indicates that the nerves are intact.

Make Sure

Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my God! Why was the prophylaxis not started?
Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected post streptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.

  Quote of the Day (Dr GM Singh)

Procrastination is, hands down, our favorite form of self-sabotage. Alyce P. Cornyn-Selby

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  Legal Question of the Day (Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. Registration of the centre was suspended under section 20(3) of the PCPNDT Act by the commissioner & MOH of Mahanagarpalika in his capacity of AA. The owner appealed to the District Collector. The AA objected, saying that appeal cannot lie with the District Collector who is at the same level as the commissioner & MOH of Mahanagarpalika/AA. He pleaded that the appeal must be made to the state AA. Where does the appeal lie?


  • A copy of the PCPNDT Act is required by law to be kept at every centre. If the doctor owning the centre is supposed to keep it, he is supposed to read it. If he is supposed to read it, he is supposed to understand it and abide by it.
  • Section 24 reads as follows:

    “21. Appeal. The Genetic Counseling Centre, Genetic Laboratory or Genetic Clinic may, within thirty days from the date of receipt of the order of suspension or cancellation of registration passed by the Appropriate Authority under section 20, prefer an appeal against such order to—
    • the Central Government, where the appeal is against the order of the Central Appropriate Authority; and
    • the State Government, where the appeal is against the order of the State Appropriate Authority, in the prescribed manner.”
  • It is clear that the appeal lies with the state government as per section 21(ii) and not with the District Collector or with the state AA.
  • The confusion arises because doctors think that there is a hierarchy of AA in the sense of having a District AA and a state AA. Such thinking is without basis. The word district does not appear anywhere in the PCPNDT Act. There is nothing like a District AA. This is clear from a reading of section 17(2), reproduced below:

    “2. The State Government shall appoint, by notification in the Official Gazette, one or more Appropriate Authorities for the whole or part of the State for the purposes of this Act having regard to the intensity of the problem of pre-natal sex determination leading to female foeticide.”
  • The situation in this case is like this:
    • An AA appointed by the state govt. closed the centre under section 20(3).
    • The appeal lies with the state government (Dept. Of Family Welfare)
    Mind Teaser

Read this…………………

A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

a. Keep the client’s knee on the affected side bent for 6 hours.
b. Apply pressure to the puncture site for 30 minutes.
c. Check the client’s pedal pulses frequently.
d. Remove the dressing on the puncture site after vital signs stabilize.

Yesterday’s Mind Teaser: A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys’ ability to remove a substance from the plasma in:

a. 1 minute
b. 30 minutes
c. 1 hour
d. 24 hours

Answer for Yesterday’s Mind Teaser: a. 1 minute

Correct answers received from: Dr Arpan Gandhi, Dr BB Gupta, Dr Jainendra Upadhyay, Dr PC Das,
Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Valluri Ramarao.

Answer for 17th March Mind Teaser: d. Foul-smelling discharge from the penis

Correct answers received from: Dr KV Sarma, Dr Chandresh Jardosh, Dr Anupam Sethi Malhotra, Dr P C Das, Dr Deepali Chatterjee, Dr B.Srinivas, Dr Gracy Thomas, Dr Kanta Jain, Dr Thakor Hitendrsinh G,
Dr Suresh Arora, Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Raghavendra Jayesh, Dr Avtar Krishan, Dr B K Agarwal.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Modern Technology

1st Person: "Do you know anything about this fax-machine?"

2nd Person: "A little. What's wrong?"

1st Person: "Well, I sent a fax, and the recipient called back to say all she received was a cover-sheet and a blank page. I tried it again, and the same thing happened."

2nd Person: "How did you load the sheet?"

1st Person: "It's a pretty sensitive memo, and I didn't want anyone else to read it by accident, so I folded it so only the recipient would open it and read it."

  Medicolegal Update

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

What is postmortem discoloration?

The bluish color of postmortem discoloration does not have the same connotation as cyanosis produced during life

  • There is a gravitational pooling of blood in the veins and capillary beds of the dependent parts of the body occur since after death the body remains lying in a position and cessation of the circulation. The postmortem coloration helps a doctor to estimate the time since death.
  • The skin of deceased may show dark purple discoloration due to accumulated blood. The process begins immediately after the circulation stops, and in a person dying slowly with circulatory failure, it may be pronounced very shortly after death. Lividity is present in all bodies, although it may be inconspicuous in some and thus escape notice.
  • Postmortem lividity is first apparent about 20–30 minutes after death as dull red patches or blotches, which deepen in intensity and coalesce over the succeeding hours to form extensive areas.
  • Postmortem lividity is usually well marked in the earlobes and in the fingernail beds. In a supine corpse, there may be isolated areas of lividity over the front and sides of the neck resulting from incomplete emptying of superficial veins. If the head is slightly flexed on the neck, then lividity may have a linear distribution corresponding to the skin folds.
  • Fading of the primary pattern of lividity and development of a secondary pattern of lividity will be quicker and more complete if the body is moved.
  • Cyanide poisoning results in lividity which is described by different authors as pink, bright scarlet, and violet.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Tackling tension headaches

Monday 17th Tension headache usually develops in the afternoon, causing mild or moderate pain that may feel like dull tightness or a band of pressure. Tension headaches occur when neck, shoulder, and scalp muscles become tense.

If you suffer from headaches often, more than once or twice a week, then try the following, said Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and National VP Elect IMA and Dr Sanjay Gupta Senior Bone and Joint specialist Moolchand Medcity.

  1. Don’t skip meals.
  2. Get enough sleep.
  3. Avoid stress and fatigue.
  4. Learn physical and relaxation therapies.
  5. Apply heating pad to the neck and shoulders to relax the muscles.
  6. Exercising the muscles of neck and shoulders by strengthening and stretching them.
  7. Relaxation exercises that focus your attention on various parts of your body in order to relax and release tension and stress can also help.
  8. Learn Biofeedback relaxation techniques. Learn to recognize when you are becoming tense and then find ways to relax the muscles before they tighten so much that you develop a tension headache.
  9. Identify trigger points, at the back of the neck or in the shoulders. Injecting a local anesthetic into these areas may eliminate the pain and prevent headache.

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 31160 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, 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. My God why it is so? Who knows better smoking a curse than a learned physician?

    Knowing pretty well why you smoke, my dear gifted clinician, Why of all a cardiologist smokes and spoils his heart & vessels,

    Chest specialist so adroit treating COPD, pollutes own chest so often|A skilful surgeon having braved breast cancer inflamed arteries, High pressure so on and so forth smokes unrepentant so glaring, Why on earth a brilliant cancer surgeon smokes unashamed,

    Emits terrible smell of nicotine sitting by my side unmindful |Pharmacologists’ pathologists’ vascular surgeons bypass experts,

    Examples galore knowing human body bad effects of this evil, Custodian of health looking after sickness caused by smoke,

    Fall prey embrace death in lieu of this deadly devil |If an ignorant lay unlettered illiterate smokes,

    We frown pity ridicule warn him to last word, Telling it is instrument of death & destruction,

    How about us smoking in public what a cruel joke? Most elite noble symbol of health care and relief,

    Contradicting own observations teachings and belief, Smoking so prevalent among angels of healing and relief,

    My God why it is so? What a disbelief?
    S Dwivedi, Dean/ Principal, Professor of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research, New Delhi
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