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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

  Editorial …

25th May 2011, Wednesday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Revise your knowledge about Armpit Test

In the month of Jyestha, days are the longest in the year and the summer is at its peak. Hence, cases of heat cramp, heat exhaustion and heat stroke are expected. This trend will continue in the month of Ashadh with the rise in heat index, though the overall temperature of the environment may be low but the humidity will be high.

It is the heat index which decides occurrence of heat exhaustion and heat stroke. With high humidity, the heat index may be much higher in the presence of relatively low environmental temperature.

One should differentiate between heat cramps, heat exhaustion and heat stroke. In heat stroke, the internal temperature may be very high and may not respond to injectible or oral paracetamol. In such cases, the temperature of the body needs to be lowered over minutes and not hours. Clinically, both heat exhaustion and heat stoke may have fever, dehydration and alike symptoms. The main difference will be abnormal "arm pit test". Normally, axillae will always be wet even if a person is suffering from severe dehydration. If the axillae are dry and the person has high fever, it invariably means that he has gone from heat exhaustion to stroke and one should treat this as medical emergency.

Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Resource which has changed practice in last one year

Maintenance rituximab in follicular lymphoma

For patients with newly–diagnosed follicular lymphoma who have had at least a partial response to initial therapy, start maintenance rituximab rather than observation.

    eMedinewS Audio PostCard

Chronic Hepatitis B: Optimum vaccination schedule

Dr Neelam Mohan Speaks on
‘Hepatitis B endemicity: Intermediate endemicity zone’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Heart Care Foundation’s New Crusade

Poster depicting messages about dangers of smoking (Mr & Mrs Tobacco – A Social Campaign), by Heart care Foundation of India, on the occasion of World No Tobacco day, 31st May 2004.

Dr K K Aggarwal
    National News

You will be on BPL list if your annual income is Rs. 27,000

New Delhi: The income limit for households for qualifying as a beneficiary under the BPL (below poverty line) list has been pegged at about Rs. 27,000 per annum, according to the methodology approved by the Union Cabinet on Thursday. A household with an annual earning of more than Rs. 27,000 will stand excluded from the BPL list. This is what the automatic exclusion and automatic inclusion criteria and the seven deprivation indicators are supposed to aim at. The upper limit has been arrived at by allowing five earning persons in a household with a per capita monthly income of about Rs. 447 per month in the rural areas, which works out roughly to Rs. 2,250 per month per household. (Source: The Hindu, May 21, 2011)

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

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

Walking prescribed for patients with depression

Giving pedometers to patients screened for depression, HealthPartners Medical Group (HPMG) is prescribing walking or exercise in addition to medication and/or therapy as an effective tool in helping patients with depression. It is estimated that 19 million Americans are living with depression, and three–quarters of patients with severe depression first seek help through their primary care clinic. The average person waits nearly a decade before seeking treatment for mental illnesses.

(Dr GM Singh)

About 3% of cancer cases that affect women are ovarian cancer

Following factors increase a woman’s risk of cancer of the ovary:

  • Being 40 or older
  • Being white
  • Having never been pregnant, or having a first pregnancy at age 30 or older
  • Having a family history of colorectal, breast or ovarian cancer
  • Having had breast cancer yourself
  • Having gone through menopause at age 50 or older
  • Having taken fertility medication

(Dr Monica and Brahm Vasudev)

Revisiting testosterone Tx in prostate Ca

Men with low–risk prostate cancer and symptomatic hypogonadism had no evidence of cancer progression during long–term testosterone therapy, results of a small clinical trial showed. Neither the mean PSA level nor prostate volume changed significantly during testosterone treatment that continued for as long as eight years, according to Abraham Morgentaler, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues. (Medpage Today)

Plaque raises acute cardiac risk in RA

Patients with rheumatoid arthritis found to have atherosclerosis as evidenced by the presence of carotid plaque are at high risk for acute coronary events, a prospective study confirmed. Among RA patients with no carotid plaque and no history of coronary events, the incidence of new acute events was 1.1 (95% CI 0.6 to 1.7) per 100 person–years, according to Inmaculada del Rincón, MD, of the University of Texas at San Antonio, and colleagues. In contrast, the incidence among those with plaque in one internal carotid artery was 2.5 (95% CI 1.7 to 3.8) per 100 person–years and 4.3 (95% CI 2.9 to 6.3) in those with bilateral plaque, the researchers reported in the May Arthritis & Rheumatism. (Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Remember anything that is bad for your heart is bad for your brain.

@DeepakChopra: In response to some questions: Our real identity is a non–local consciousness in which the observer and observed simultaneously co–arise

    Spiritual Update

Hanuman Chalisa

Aapan Tej Samharo Aapai
Teenho Lok Hank Te Kanpai

Meaning: Your radiance is supreme, and the three worlds (entire universe) tremble when you move.

Spiritual Significance: Regular Pranayama increases the Tejas in the body and controls all physical, causal and subtle bodies (sthool, karan and sukshma sharir).

    An Inspirational Story

(Dr. Anupama Sethi Malhotra)

Love the Pricks

Many animals died because of the cold. The porcupines, realizing the situation, decided to group together. This way they covered and protected themselves; but the quills of each one wounded their closest companions even though they gave off heat to each other. After awhile, they decided to distance themselves one from the other and they began to die, alone and frozen. So they had to make a choice: either accept the quills of their companions or disappear from the Earth. Wisely, they decided to go back to being together. This way they learned to live with the little wounds that were caused by the close relationship with their companion, but the most important part of it, was the heat that came from the others. This way they were able to survive.

Moral of the story: The best relationship is not the one that brings together perfect people, but the best is when each individual learns to live with the imperfections of others and can admire the other person’s good qualities. In other words: Learn to love the pricks in your life.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How should matching of male partner with donor be done?

There are several methods for matching the male partner with the donor. The couple should be encouraged to list the characteristics that they desire in a prospective donor, including race and/or ethnic group, height, body build, complexion, eye color, and hair color and texture. Consideration should be given to blood type and Rh factor, particularly for Rh-negative recipients.

    Pediatric Update

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

What are the differential diagnoses of bronchiolitis?

The absence of antecedent upper respiratory tract symptoms should suggest to clinicians that an infant with the acute onset of wheezing might not have bronchiolitis. In newborns, congenital anomalies, such as a vascular ring or congenital heart disease, should be considered. Gastroesophageal reflux, aspiration pneumonia, or foreign body aspiration can mimic the symptoms of bronchiolitis.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with FUO came for an MRI prescription.
Dr. Bad: Go ahead and do it.
Dr. Good: It is not required.
Lesson: While MRI scan can be more sensitive than a CT scan of abdomen, for example, for the diagnosis of spinal epidural absence, it is rarely required in the initial evaluation of FUO.

Make Sure

Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI.
Reaction: Oh my God! Why was a statin not started earlier?
Lesson: Make sure that all patients with even normal cholesterol are considered for statins if the hsCRP is high.

    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Can I eat sugar?

With a malabsorptive gastric bypass, sugar is no longer well tolerated. Consuming more than a spoonful or two at a time will lead to a very uncomfortable sensation known as dumping, which occurs when the sugar enters the bloodstream mostly undigested. The result is a rapid pulse, sweating, nausea and lightheadedness. Lying down until the feeling passes––typically 30 to 45 minutes––is generally required.

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  SMS of the Day

(Dr GM Singh)

Make your anger so expensive that no one can afford it and make your happiness so cheap that people get it free from you.

    Medicolegal Update

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

Medicolegal cases & injury, assault and hurt in Indian law

The words injury, assault and hurt are invariably used by doctor in hospital practice and are used as synonymous. But all three have a different meaning as per law. It is defined by the Indian Penal Code as below:

  • Injury: Section 44 of IPC defines injury as any harm whatever illegally caused to any person in body, mind, reputation or property.
  • Assault: Section 351 of IPC defines assault as an offer or threat or attempt to apply force on body of another in a hostile manner. It may be a common/simple assault or an intention to murder.
  • Hurt: Section 319 of IPC defines hurt as whoever causes bodily pain, disease or infirmity to any person is said to cause hurt.

When we as doctors deal with cases of Hurt/body injury, it means bodily pain, wound, disease or infirmity voluntarily caused to any person in medicolegal cases. These would include abrasions, contusions, lacerations, stab wounds, electric shock, firearm or ligatures etc resulting in human body injury. The doctor who is certifying an injury report should keep in mind the Penal provisions required by police to book the case i.e.

  • Simple injury: IPC Section 323
  • Simple injury caused by dangerous weapons: IPC Section 324
  • Grievous injury: IPC Section 325
  • Grievous injury caused by dangerous weapons: IPC Section 326
  • Dangerous injury: IPC Section 307
  • Injury likely to cause death: IPC Section 304
  • Injury sufficient to cause death: IPC Section 302
  • Causing hurt by means of poison: IPC Section 328
  Vitamins—Open Secrets revealed

(Dr Jitendra Ingole, MD Internal Medicine)

Vegetarians are vitamin B12 deficient

It is generally assumed that vitamin B12 deficiencies are rare among people consuming a varied diet. However, there is some question whether vegetarians get enough B12 as it is not present in plants. Researchers at the Sydney Adventist Hospital have just completed a study aimed at resolving this question. Their study involved 245 Adventist ministers who were either lactoovovegetarians or vegans. The average age of the ministers was 46 years (range 22 to 80 years) and most of them had been vegetarians for over 20 years. The study participants filled out a diet questionnaire and had a fasting blood sample drawn for a 20–test biochemical profile including vitamin B12 concentrations. The mean vitamin B12 level was 199 pmol/L and 73 per cent of the ministers had a level below the recommended lower limit of 221 pmol/L. Vitamin B12 concentrations were also measured in a control group of 53 ministers who consumed fish, poultry or red meat on a regular basis. In this group 40 per cent had vitamin B12 concentrations below the recommended lower limit; this indicates that vitamin B12 deficiency is widespread even among non–vegetarians.

(Ref: Hokin BD, Butler T. Cyanocobalamin (vitamin B–12) status in Seventh–day Adventist ministers in Australia. Am J Clin Nutr 1999 Sep;70(3 Suppl):576S–578S)

    Mind Teaser

Read this…………………
(Dr GM Singh) 

The SA node acts as a pacemaker of the heart because of the fact that it:

1. Is capable of generating impulses spontaneously
2. Has rich sympathetic innervations
3. Has poor cholinergic innervations
4. Generates impulses at the highest rate

Yesterday’s Mind Teaser: A body is brought for autopsy with history of Poisoning. On postmortem examination, there is staining and garlic odor in stomach. In this case, the poisoning is most likely due to?

A. Hydrocyanic acid
B. Carbon dioxide
C. Aniline dye
D. Phosphorus

Answer for yesterday’s Mind Teaser: D. Phosphorus

Correct answers received from: Dr D Chatterjee, Dr Muthumperumal Thirumalpillai, Dr Neelam Nath,
Dr Samueal, Dr Chitra, Dr Surveysh, Dr Pulkit, Dr Dharmesh, Dr Rajesh, Dr Sumit, Dr Rajeev, Dr Ketan,
Dr Kripal, Dr Lalait, Dr Fiza, Dr Kaniska.

Answer for 23rd May Mind Teaser: A Coffin!
Correct answers received from: Dr Anupam, Dr Shreysh, Dr Aakriti, Dr Bhavana, Dr Chnadra,
Dr Pankaj, Dr Neena, Dr Shobhna.

Send your answer to ijcp12@gmail.com

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Hypophosphatemia can be seen in a variety of biochemical derangements, including acute alcohol intoxication, sepsis, hypokalemia, malabsorption syndromes, hyperinsulinism, hyperparathyroidism, and as result of drugs, e.g., acetazolamide, aluminum–containing antacids, anesthetic agents, anticonvulsants, and estrogens (incl. oral contraceptives). Citrates, mannitol, oxalate, tartrate, and phenothiazines may produce spuriously low phosphorous by interference with the assay.

    Medi Finance Update

Money Market Funds

Money market funds invest primarily in short–term (less than one year) government Treasury Bills (also called T–Bills) and corporate notes which pay a fixed rate of interest.

    Laugh a While

(Dr. GM Singh)

Generation Gap

My neighbor’s 12–year–old skinny lanky son needed a new shirt. They took him to a shopping mall and the search begin. In the boys’ department, the target size was too small. They moved to the men’s department where the size was too big. With the largest size in one hand and the smallest men size in the other, his wife gave him a long look. "Son" she said at last," do you realize you are now in the generation gap?"

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Acyclovir SR Tablet 1200 mg

For the treatment of uncomplicated Herpes Zoster in immunocompetent patients.


    IMSA Update

International Medical Science Academy (IMSA) Update

Nocturnal leg cramps

A systematic review of prospective trials identified limited data to support the use of several agents, including calcium channel blockers and vitamin B complex, in the treatment of nocturnal leg cramps.

(Ref: Katzberg HD, et al. Assessment: Symptomatic treatment for muscle cramps (an evidence–based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;74:691).

    Public Forum

(Press Release for use by the newspapers )

Quitting smoking

Cigarette is responsible for over 50 lakh premature deaths all over the world making it a leading preventable cause of death, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India.

The important causes of smoking–related mortality include heart diseases and chronic obstructive lung disease. Quitting smoking involves the combination of behavioural therapy and drugs. Combination therapy is clearly superior to counseling alone or drugs alone. Drug therapy involves giving a varenicline or combined nicotine replacement.

Following are few tips that may help to quit smoking:

  • Set a target date to complete quit smoking.
  • Talk with your doctor regarding quitting.
  • Exercise daily.
  • Practice deep breathing exercises daily for 5 minutes.
  • Identify triggers that increase your desire for a cigarette and avoid them.
  • Try alternative ways such as putting clove oil in the lower part of tongue 3 to 4 times daily and/or chewing clove (laung), fennel (saunf), cardamom (ilaichi) 3–4 times a day.
  • Eat more fresh fruits and vegetables, and drink a lot of liquids.
  • Avoid company of people who smoke.
  • Avoid a smoke atmosphere.
  • Join a support group.
  • Above all, have faith in yourself.
    Readers Responses
  1. Dear Dr. KK Aggarwal, Sir, I have come to know through a news article that according to MCI, 30 hours credit hours CME in 5 years will be necessary for renewal of registration with State medical Council. Is there any authentic source of this information? and where can these CME be undertaken. Kindly inform. Thanks, Dr. AK Saxena.
    eMedinewS Special

1. eMedinewS audio PPT (This may take a few minutes to download)

2. eMedinewS audio lectures (This may take a few minutes to open)

3. eMedinewS ebooks (This may take a few minutes to open)

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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