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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 …

28th September 2011, Wednesday

28th September is World Rabies Day

  1. Bites, scratches, abrasions, or contact with animal saliva via mucous membranes or a break in the skin can transmit rabies.
  2. Early wound cleansing is an important prophylactic measure in addition to timely administration of rabies immune globulin and vaccine
  3. Dog, cat and bats can transmit rabies
  4. Raccoons, skunks, foxes and coyotes can transmit rabies
  5. Rabies has been reported in large rodents (woodchucks and beavers).
  6. Small rodents, such as squirrels, chipmunks, rats, hamsters, gerbils, guinea pigs, mice, and lagomorphs (rabbits and hares) are almost never identified as infected with rabies virus; there has never been a case of transmission to a human from one of these animals.
  7. Data from rabies pathogenesis studies in dogs, cats, and ferrets indicate that these animals uniformly begin to sicken and die within 10 days (usually 5 to 7 days) of spread of rabies virus from the CNS to the salivary glands. If the animal remains healthy for the full 10 days, then it did not have rabies virus in its saliva at the time of exposure.
  8. Post exposure prophylaxis should be given immediately if an exposing animal is rabid or suspected to be rabid. If the animal is available for observation, immediate prophylaxis is indicated when the animal develops clinical signs of illness. In addition, prophylaxis should be started if the person's significant exposure is to the head or neck, since incubation periods as short as four days have been reported in bites this close to the central nervous system. If the animal remains well for 10 days, the regimen can be discontinued at that time. If the animal is tested for rabies and is found negative, prophylaxis can be discontinued
  9. Pre exposure prophylaxis should be targeted to persons in high–risk groups, including veterinarians, laboratory workers and international travelers.

For More editorials...

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

28th September is World Rabies Day

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Anmol - A Health Festival for Children with Special Needs - 2010

This unique event is organized every year to spread the message in the community that disabled children, If they lose one of the faculties in the body, they compensate it by cultivating some other faculty.

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


Lack of health workers jeopardises infant

Children born in India are five times more likely to die before their fifth birthday because of lack of access to trained health workers. India has a shortage of 2.6 million health workers, according to a new report released by Save the Children, an international NGO on Tuesday. This falls way below the World Health Organization health worker threshold of 2.3 health workers per 1000 people. Madhya Pradesh tops the list with a shortage of 88% health workers followed by Uttar Pradesh and Bihar at 87% and 82%. According to the report, this shortfall means that close to 1.2 million children below the age of one die every year in India from easily preventable diseases like pneumonia and diarrhea because of lack of access to a trained health worker which includes doctors at primary health centres, auxiliary nurse midwives and anganwadi workers. (Source: Hindustan Times, September 21, 2011)

For Comments and archives

Moolchand Heart Hospital™ organizes Heart Awareness Week

To commemorate World Heart Day, Moolchand Heart Hospital™ is organizing a Heart Awareness Week. The free offerings at this Heart Awareness Week are: Consultation by senior cardiologist, ECG, ECHO, cholesterol test, blood sugar estimation, height, weight, BMI estimation, blood pressure and second opinion on possible procedure and surgeries. The tests available at the camp with upto 50% discount are: Lipid profile, TMT, Stress ECHO, Holter, Chest x–ray, ECHO colour Doppler and Lab packages. Angiography is being offered at a price of Rs. 6,999 only.

Heart Awareness Week Details

Date: September 29, 2011
Timing: 10:30 am to 03:00 pm, Venue: Dilli Haat, opposite INA Market, Kidwai Nagar, New Delhi 110 024

For more information, please call Program Coordinator at + 91 99589 97293

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)

Antioxidants may not lower blood pressure

Moderate red wine consumption is associated with a lower risk of cardiovascular disease but red wine component–antioxidants does not lower blood pressure according to a study presented at the American Heart Association’s High Blood Pressure Research 2011 Scientific Sessions.

For comments and archives

Obese people may spend extra years dealing with diabetes

An obese man can expect to live almost six more years of his life with diabetes, compared to the same estimate in the 1980s according to a study published in the October issue of Diabetes Care. For women, the extra time with diabetes is now 2.5 years.

For comments and archives

Limiting calcineurin inhibitor use after kidney transplantation improve outcomes

Limiting the use of calcineurin inhibitors following kidney transplantation may improve clinical outcomes, although not all of the newer regimens are of equal value, according to a meta–analysis published online Sept. 23 in the Journal of the American Society of Nephrology.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Do not wait for happy situations. Make every situation a happy situation.

@DeepakChopra: #CosmicConsciousness We are a part of collective awareness. We contribute to it and are influenced by it. Our karma is intertwined.

    Dr KK Answers

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

How to handle patients on nitrates who want to take Viagra group of drugs?

  1. Men treated with PDE–5 inhibitors (Viagra group of drugs) and nitrates are at risk for severe hypotension and syncope (loss of consciousness).
  2. Co–administration of Viagra group of drugs (sildenafil) with isosorbide mononitrate or sublingual nitroglycerin lowers blood pressure (52/29 mmHg with isosorbide mononitrate and 36/21 mmHg with sublingual nitroglycerin).
  3. In men on Viagra group of drugs with chest pain nitrates should not be administered for 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil.

For comments and archives

    Spiritual Update

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

Navratri: Time to eat buckwheat flour

Navratri is the time to omit wheat flour from the diet and substitute it with buckwheat flour or kuttu ka aata. It’s not a cereal but is classified under a fruit and hence is a good substitute for Navratri fast where cereals are prohibited………more

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Which provisions of the RTI Act may come in the way of providing an MLC report to an applicant?

QUESTION–If anybody in the public makes an application to a government hospital for supplying a copy of the MLC report in respect of any person, is the hospital bound to give it? If the hospital thinks it will not be proper to give it, under what provisions of the RTI Act, 2005, can it be denied?


  1. No, the hospital is not bound to provide a copy of MLC report in respect of a person to anybody who asks for it.
  2. The sections of the RTI Act that may be quoted by the PIO while rejecting the application are listed below. All of these may not be applicable to each case. The applicability will depend upon the facts of the case.

Section 7(7)
Section 8(b)
Section 8(d)
Section 8(e)
Section 8(g)
Section 8(h)
Section 8(j)
Section 11

For comments and archives

    An Inspirational Story

(Dr Anil Kumar Jain)

Duty bound (Part two)

He tried to console his daughter, "It is futile Devayani to bring Kacha to life. The Asuras are determined to get rid of him. A wise soul, like you, should not grieve at a loved one’s death. You are young and beautiful and you have your own life to live."

But Devayani was adamant. So strong was her love for Kacha. "Father" she said, "Kacha was your best student. I am in love with him. I cannot live without him."

Devayani stopped eating. Shukracharya could no longer bear to see his daughter in such agony. Again Shukracharya used his secret knowledge and called upon Kacha to come back to the world of the living. Kacha came back to life and spoke from inside the stomach of Shukracharya. "The Asuras killed me but I do not know how I happen to be inside your stomach?" echoed Kacha.

Shukracharya cursed himself for drinking the wine given by the Asuras. "Henceforth, wine shall be forbidden for those engaged in the pursuit of wisdom," declared Shukracharya in great frustration. Now Shukracharya had a real dilemma of his own. He could ask Kacha to come out but that would mean his own death.

When he told Devayani of his dilemma she was again adamant, "Father, I cannot live if either of you dies."

After long deliberation Shukracharya thought of a way out. He now knew the real purpose of Kacha’s visit. He addressed Kacha, "I now see why you came and truly you have succeeded. There is only one way by which both of us can ensure Devayani’s happiness. I will have to teach you the craft of Mritasanjivani.

With his new knowledge Kacha emerged from Shukracharya’s dying body and then immediately brought his guru back to life. Shukracharya could not have been happier with his pupil's progress.

When the Asuras came to offer him wine, Shukracharya shouted, "You fools! Kacha now knows my secret. You helped him learn by your foolish deeds. But rest assured Kacha will continue to live with me because of his love for Devayani.

But Shukracharya was wrong. Kacha too faced the troubling dilemma. Waiting for the period of his studies to come to an end, Kacha kept silent. While his love for Devayani was deep, his sense of duty towards the devas was no less strong.

On the last the day of his studies, Kacha went to Shukracharya for his blessing. As a wise man and a dedicated teacher, Shukracharya concealed his grudge against Kacha but he was wondering how Kacha was going to bid farewell to Devayani.

Devayani waited for Kacha to propose marriage. But when Kacha broke the heartbreaking news that he was going to fulfill his obligations to his own people, her joy turned to tears. Devayani pleaded with Kacha to take her as his wife. But Kacha replied, "Peerless one! I was reborn in your father’s stomach. I am therefore your brother. I can’t marry you. I must return to heaven."

The broken–hearted Devayani cried out in her grief. She accused Kacha of using her to attain his goal. Distort she cursed Kacha, "You will never be able to use the craft of Mritasanjivani."

Kacha quietly listened and then spoke, "Devayani, it is wrong to curse me. I could have walked away without reviving your father. There is no doubt that my love was sincere and truthful. But, I also have a duty to perform towards my own people. Because of your unfairness to me, I am cursing you. No Rishi’s son will ever marry you. I may still teach the craft of Mritasanjivani to others, even though I may not be able to use it myself." Saying this Kacha departed for the abode of Indra, king of the Devas. Shukracharya gently led Devayani away.

For comments and archives

    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

How can one suspect/diagnose a case of malaria?

Person affected with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma depending upon the end organ involvement and can die from the infection or its complications. Cerebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. The patient may die, if not treated quickly; even with treatment; about 15%–20% deaths occur.

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    Medicine Update

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

How do we diagnose galactosemia?

Diagnosis is made by demonstration of reduced or absent activity of the enzyme galactose–1–phosphate uridyl transferase (GAL–1–PUT) which is central to galactose metabolism. This test is invalid if the child has received a blood transfusion within previous two months. Parents’ samples should be sent instead for carrier testing.

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 ChairpersonDr Kaberi Banerjee

Day1 Interesting Highlights

Panel Discussion 1–Obstetric Outcome in ART Pregnancies

This interesting panel discussion will cover all aspects relevant to ART pregnancies. This would include miscarriages, multiple pregnancies, congenital malformations, fetal reductions and preterm deliveries.

Panelists: Anita Kaul, New Delhi; Sudarshan Ghosh Dastidar, Kolkata; Nandita Dimri, New Delhi; Ashutosh Gupta, New Delhi; Jaishree Sundar, New Delhi; Kiran Guleria, New Delhi.

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

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

For details contact +91 9871250235

For comments and archives

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests for Pancreatitis

Serum Amylase: Increases from 2 to 12 hours after symptoms and peaks at 12 to 72 hours. It may rise to 5 to 10 times the normal level and usually returns to normal within a week.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady died.
Dr Bad: Declare her dead.
Dr Good: Deliver the infant within 5 minutes.
Lesson: "Five minute rule", the best outcome with regards to neonatal neurological outcome is most likely when delivery occurs within five minutes of maternal cardiac arrest.

For comments and archives

Make Sure

Situation: A rape victim became pregnant.
Reaction: Oh my God! Why was an emergency contraceptive not given to her?
Lesson: Make sure that all victims of rape are given an emergency contraceptive.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Prosperity makes friends, adversity tries them. Publilius Syrus


Like a chicken with its head cut off: To act in a frenzied manner.

  Sri Chanakya Niti–Sastra: The Political Ethics of Chanakya Pandit

(Dr Anupam Sethi Malhotra)

Do not stay for a single day where there are not these five persons: a wealthy man, a Brahmin well versed in Vedic lore, a king, a river and a physician.

    Medicolegal Update

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

The concept of ‘required request’ required in cadaver organ retrieval for transplantation

The concept of ‘required request’ requires to be introduced, wherein hospitals will be allowed to ask ICU patients, whether they would be willing to donate organs.

  • It should be made mandatory for hospital ICUs to declare all brain deaths and register them with an online central organ registry for better coordination of cadaver organ donation, retrieval and transplantation.
  • In India, certain amendments to the Human Organ Transplant Act 1994 are required to enhance cadaver organ retrieval and transplantation to bridge the huge demand-supply gap.
  • The pool of donors, including increasing the supply of organs by widening the definition of ‘near relatives’ by allowing organ swaps among needy families, as well as, simplifying cadaver transplant procedures. Paired matching should be permitted i.e. if patient A’s donor does not match A and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families enable to fulfill the need of their family member in need of a transplant
  • Hospitals equipped with ventilators and artificial life support system must make mandatory effort to coordinate with organ bank and retrieve organs and the reason of failure must be documented for further review.
  • The World Medical Association (WMA) recommends that "The physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment."
  • These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

For comments and archives

    Mind Teaser

Read this…………………

Which of the following HPV types are included in the quadrivalent HPV vaccine?


Yesterday’s Mind Teaser: Most common site of metastasis in breast cancer is

a. Lung
b. Liver
c. Bone
d. Brain

Answer for yesterday’s Mind Teaser: b. Liver

Correct answers received from: Dr Shirish Singhal, Dr Sudipto Samaddar, Jayashree Nayar,
Dr Chandresh Jardosh, Dr K Raju, Dr Surendra Bahadur Mathur, Dr Prabodh Kumar Gupta, Neelam Nath,
Dr Jainendra Upadhyay, Anil Bairaria, Dr Chandresh Jardosh, Dr Dilip Kumar Jha, Dr Sudipto Samaddar.

Answer for 26th September Mind Teaser: Make No difference
Correct answers received from: Dr Chandresh Jardosh, Dr Dilip Kumar Jha, Dr Sudipto Samaddar.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Chandresh Jardosh)

Santa once visited my hospital at Delhi and asked about his problem of obesity. I advised him to walk 15 km daily to reduce his weight. After about one month Santa phoned me–‘Sir I am losing weight but Pakistanis are not allowing me to cross the Wagha border though I have shown them your prescription to walk 15 km daily."

    Drug Update

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

Drug Name


DCI Approval Date

Diclofenac Cholestyramine 145.6 mg corresponding to 75mg diclofenac Sodium Capsules.

For the treatment of acute arthritis (including attacks of gout), chronic arthritis especially rheumatoid arthritis (chronic polyarthritis), ankylosing spondylitis (Morbus Bechterew) and other inflammatory, rheumatoid syndromes of vertebral column.


    Public Forum

(Press Release for use by the newspapers)

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

Beware of food poisoning during Navratri

Its Navratri time and people start eating Vrata flours like kuttu and singhara. Food poisoning may occur if flour left over from previous year is used, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Food poisoning is common. One in five episodes of diarrhea is likely to be due to a food poisoning. Each person on average has diarrhea once or twice per year. An average person will have a food poisoning once every three to four years.

Always consider a food–borne illness when a patient presents with a mixture of gastrointestinal symptoms: nausea, vomiting, abdominal pain, diarrhea and fever.

Botulism and some types of shellfish poisoning can present with paralysis; ciguatera or scombroid fish poisoning with headaches and tingling; amnesic shellfish poisoning with amnesia; hepatitis A or E with hepatitis and Listeria monocytogenes with meningitis or spontaneous abortion.

More than 200 agents are known to cause food poisoning (microbial causes, chemicals and other agents). Five organisms account for 90 percent of the deaths, most notably Salmonella spp.

About 1.2% persons have complications such as intestinal perforation or invasive illness.

Listeriosis, Shiga toxin–producing E. coli and non typhoidal Salmonella are particularly associated with severe morbidity.

One can classify food poisoning depending on the onset of symptoms

  • Rapid symptoms within 6–12 hours: Due to organisms that produce toxin in the food before it is consumed. Vomiting is the predominant symptom. Examples are Staphylococcus aureus, Bacillus cereus emetic toxin and botulism.
  • Symptoms after 24 hours: Due to pathogens that produce toxin once they have been ingested. They mainly cause diarrhea that may be watery (Vibrio cholerae or E. coli) or bloody (Shiga toxin–producing E. coli).
  • Symptoms after variable time: Due to microbes that cause pathology by either damaging the epithelial cell surface or by actually invading across the intestinal epithelial cell barrier. They can produce a wide spectrum of clinical presentations ranging from watery diarrhea (Cryptosporidium parvum, enteric viruses) to inflammatory diarrhea (Salmonella, Campylobacter, Shigella) or systemic disease (L. monocytogenes).

Food poisoning can also be classified depending on the type of symptoms: vomiting or diarrhea. A sudden onset of nausea and vomiting is likely due to the ingestion of a preformed toxin, such as S. aureus enterotoxin or B. cereus emetic toxin, or a chemical irritant. There is no risk of person–to–person spread.

When food poisoning presents with diarrhea, the likely organisms are V. cholerae, Clostridium perfringens, enterotoxigenic E. coli, B. cereus, rotavirus, astroviruses, enteric adenoviruses, and Noroviruses, and the parasitic organisms, Cryptosporidium parvum and Cyclospora cayetanensis.

There are clinical clues that should increase suspicion that a food borne microbe is causing inflammatory diarrhea. Such symptoms and signs include: Passage of diarrhea with blood or mucus; Presence of severe abdominal pain and occurrence of fever. The most likely pathogens in patients with inflammatory diarrhea are Salmonella or Campylobacter.

For comments and archives

    Readers Responses
  1. Dear Dr Aggarwal, This is fantastic on line newsletter.Subject matter is wide from medicine to a tinge of spirituality which we so much need in a profession like ours, were an emotional disconnect often happens in the rush of professional engagements.Warm Regards Dr. A.V.Pathak
    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