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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 …

1st August 2011, Monday

Paracetamol Update

What is the difference between Paracetamol and acetaminophen?

They are same. In India it is called Paracetamol and in America it is known as acetaminophen.

How common is paracetamol (acetaminophen) poisoning?

Acetaminophen (Paracetamol) is widely available and lay people commonly underestimate its toxicity. Acetaminophen accounts for more overdoses and overdose death each year in the United States than any other drug. Acetaminophen-induced acute liver failure is common; 50% of them being intentional or suicidal and other 50% unintentional or cardiac poisoning.

What is the therapeutic dose of paracetamol (acetaminophen)?

The therapeutic dose is 10–25 mg/kg per dose in children and 325–1000 ml per dose in adults given every 4–6 hours with maximum recommended daily dose of 80mg/kg for children and 3 gm in adults.

3g is the recent change from an early recommendation of 4gm in adults.

What is the toxic dose of paracetamol (acetaminophen)?

Toxicity is unlikely to result from a single dose of less than 150mg/kg in children or 7.5–10 gm in adults. Toxicity is likely to occur with a single ingestion greater than 250 mg/kg or dose greater than 12 gm over a 24 hour period.

At what dose does paracetamol (acetaminophen) cause acute liver failure?

Practically all patients who take paracetamol (acetaminophen) in excess of 350 mg/kg develop severe liver toxicity unless appropriately treated. Clinically they present with SGOT or SGPT levels (AST or ALT) > 1000 IU/L.

What is the maximum dose of paracetamol (acetaminophen) which can be combined in another drug?

In January, the US FDA mandated drug makers to include not more than 325 mg of Paracetamol in each tablet or capsule of combination medicines.

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

Paracetamol Update

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight
on Medicolegal Issues

Doctors participated in large numbers in the National Conference on Insight on Medicoleagl Issues held on 10th July, 2011. In the Photo: Doctors at the registration counter

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


‘Indians most depressed’: Govt rubbishes WHO study

The Union health ministry on Thursday rejected media reports which cited a World Health Organisation–sponsored study to claim that Indians were the most depressed in the world. After conducting a thorough analysis of the report titled "Cross–national Epidemiology of DSM–IV Major Depressive Episode (MDE)", published in BMC Medicine Journal, top health ministry officials on Thursday said the media reports, which suggested that Indians as the most depressed globally, "were gross misrepresentation of the data in the WHO study. In an elaborate clarification issued on Thursday, the ministry said the lifetime prevalence of depression among Indians, that too among the respondents from Pondicherry (now Puducherry) – the only area covered by the WHO report, was just 9 per cent and not 36 per cent, as claimed by the news reports. "The reports in the media are based on complete misrepresentation of the facts and picked up after wrongly reading the columns in the survey data," said a ministry release issued in New Delhi.
(Source: http://www.rediff.com/news/report/indians–most–depressed–govt–rubbishes–who–study/20110728.htm, July 28, 2011) For comments and archives

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

    International News

(Dr Monica and Brahm Vasudev)

Tamoxifen legacy lasts long term

The reductions in breast cancer recurrence and mortality seen with tamoxifen persist past the first decade, researchers found in a long–term analysis. Treatment for about five years cut annual breast–cancer mortality by 30% throughout the first 15 years after the start of treatment (P<0.00001) across the 20 randomized trials pooled by the Early Breast Cancer Trialists’ Collaborative Group. Earlier benefits in terms of relapse appeared maintained beyond year 10, the group reported online in The Lancet. (Source: Medpage Today) For comments and archives

Gabapentin in renal failure pruritus

Patients with end–stage renal disease (ESRD) are commonly afflicted by severe pruritus. The pathogenesis is unknown, but improving the quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Broadband ultraviolet phototherapy can be extremely beneficial. Gabapentin has been recently discovered as an effective agent for the patient with ESRD pruritus (Berger TG, Steinhoff M. Semin Cutan Med Surg 2011 Jun;30(2):99–100). For comments and archives

Doubling clopidogrel dose restores loss of antiplatelet effect induced by esomeprazole

There is a strong negative clopidogrel/esomeprazole interaction, compensated by increasing the dose of clopidogrel to 150mg or replacing esomeprazole with ranitidine. This could be a simple solution to the PPI–induced clopidogrel resistance (Moceri P, Doyen D, Cerboni P, Ferrari E. Thromb Res 2011 Jul 19. Epub ahead of print). For comments and archives

    Fitness Update

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

More exercise is recommended for MS patients

Multiple sclerosis (MS) is an autoimmune disease that causes inflammation in the brain and spinal cord. Research shows that individuals who suffer from MS also have an increased rate of atherosclerosis, which is associated with disease progression as well as cardiovascular disease.

The study, conducted at the University of Illinois’s Department of Kinesiology and Community Health, compared atherosclerosis, arterial function and risk of cardiovascular disease in people with and without MS. Participants consisted of 33 MS patients and 33 healthy individuals; all participants were matched for age, sex and BMI. The study used several tests of arterial function as well as accelerometer data, and found that MS patients engaged in significantly less activity than their healthy counterparts. Data analyses were able to make a direct link between the two, leading researchers to conclude that the decreased arterial function and increased atherosclerosis were directly caused by decreased levels of physical activity. The study recommends that medical experts find new ways to incorporate mild forms of physical activity in MS treatment, as this would decrease rates of cardiovascular disease and slow disease progression. For comments and archives

    Twitter of the Day

@DrKKAggarwal: #AJOR Overall, MRI resulted in no improvements over radiography in terms of disability, pain or general health… http://fb.me/18apkl10S

@DeepakChopra: CosmicConsciousness Symbols of reality: Coffee without caffeine, beer without alcohol, exercise on a machine, sex from the internet

    Dr KK Answers

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

Is raw milk safe?

One should not consume raw milk. As per Centers for Disease Control and Prevention (CDC), USA one should not consume raw (unpasteurized) milk or raw milk products because of the risk of E. coli O157:H7 and other infections. For comments and archives

    Spiritual Update

Can I take Curd in Dinner?

According to Charaka Samhita, the Bible of Ayurvedic text, one should not take curd, a predigested fermented food, at night. This rule of Ayurveda has created a lot of controversy between doctors of Ayurveda and Modern System of medicine. In fact, both Chinese and Ayurveda medicine clearly docum

For comments and archives

    An Inspirational Story

(Prof. Dr. Charu)

A good lesson

A man was lost while driving through the countryside. As he tried to reach for the map, he accidentally drove off the road into a ditch. Though he wasn’t injured, his car was stuck deep in the mud. So the man walked to a nearby farm to ask for help. "Warwick can get you out of that ditch," said the farmer, pointing to an old mule standing in a field. The man looked at the decrepit old mule and looked at the farmer who just stood there repeating, "Yep, old Warwick can do the job." The man figured he had nothing to lose. The two men and the mule made their way back to the ditch. The farmer hitched the mule to the car. With a snap of the reins, he shouted, "Pull, Fred! Pull, Jack! Pull, Ted! Pull, Warwick!" And the mule pulled that car right out of the ditch.

The man was amazed. He thanked the farmer, patted the mule, and asked, "Why did you call out all of those names before you called Warwick?"

The farmer grinned and said, "Old Warwick is just about blind. As long as he believes he’s part of a team, he doesn't mind pulling."

Keep your words positive, because your words become your actions.
Keep your actions positive, because your actions become your habits.
Keep your habits positive, because your habits become your lifestyle.
Keep your lifestyle positive, because your lifestyle becomes your destiny.

For comments and archives


(By Ritu Sinha)

All bark and no bite: When someone is threatening and/or aggressive but not willing to engage in a fight.

    Pediatric Update

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

What is spasmodic and recurrent croup?

Spasmodic and recurrent croup defines a sudden onset of symptoms, identical to viral croup, at night in a child who has been well. The symptoms last for few hours rather than days and usually there is no fever. The episodes are seldom life threatening. The child may be well during the day and have attacks on 3 to 4 successive evenings. During the first attack, it is difficult to make an accurate diagnostic distinction from viral croup. Spasmodic croup occurs most often in children with atopic tendency. For comments and archives

    Infertility Update

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

What is the importance of varicella vaccine?

Varicella vaccine contains live attenuated virus. The vaccine should be administered within 96 hours of exposure, and pregnancy should be avoided for one month thereafter. For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Formal name: Carcinoembryonic antigen

Carcinoembryonic antigen (CEA) is a protein found in embryonic tissues. This test is done

• To determine whether cancer is present in the body
• Before starting treatment, especially in patients with gastrointestinal cancer
• During and after therapy to monitor treatment and recovery

CEA levels are high in embryonic tissues.

Patients with smaller and early–stage tumors normally have low or normal CEA levels, while patients with more advanced tumors, or tumors that have spread throughout the body, are likely to have initially high CEA levels.

CEA levels decreased to "normal" levels after therapy means that the tumor has been removed.

If CEA levels return to rise steadily it can be the first sign of tumor recurrence.

For comments and archives

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with high triglycerides developed stroke.
Dr Bad: They are unrelated.
Dr Good: There is an association between the two.
Lesson: Men and women with high triglyceride levels are at an increased risk of ischemic stroke.

For comments and archives

Make Sure

Situation: A patient with severe OSA developed acute coronary syndrome.
Reaction: Oh my God! Why was CAD not ruled out in this case!
Lesson: Make sure that all patients with obstructive sleep apnea (OSA) are investigated for underlying coronary artery disease (CAD). For comments and archives

    Quote of the Day

(Dr Prabha Sanghi)

Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.

    Medicolegal Update

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

The direction of firing is determined from the bullet track

  • Burning, blackening and tattooing around a firearm missile entry wound is due to flame/smoke and gunpowder residue is almost suggestive of near shot. However, the accurate assessment of the range of fire requires test firing of the gun with the type of ammunition that was used in shooting.
  • It has been observed that many surgeons have opined the direction of fire arm missile on the position of wound track because a bullet usually travels through the tissues in a straight line. So, the direction of fire may be determined, by a doctor, from the bullet track.
  • In certain conditions, a bullet may be deflected from its course and this occurs most commonly when it strikes a bone in its passage through the tissues. It can also occur due to the inherent instability of a bullet as it penetrates tissues, and it may undergo change in direction within the soft tissues in its track.
  • This is illustrated by a case in which a man was struck by a bullet, which traveled through various tissues in the following order: gallbladder, hepatic flexure of colon, duodenum, pancreas, inferior vena cava, then passing medially through the bony part of the vertebral column, to strike the left kidney, spleen and pass through the diaphragm and pericardium, before coming to rest in the chest cavity.
  • The bullet in motion is very notorious. In a case where the wound of entry was on the front of chest, the bullet was recovered from scrotal sac. The only part of the track of bullet which was in a straight line was through the vertebral column.

For comments and archives

    Mind Teaser

Read this…………………

Which of the following statement is true regarding Acanthamoeba keratitis?

1. For the isolation of the causative agent, corneal scraping should be cultured on a nutrient agar plate.
2. The causative agent, Acanthamoeba is a helminth whose normal habitat is soil.
3. Keratitis due to Acanthamoeba is not seen in the immunocompromised host.
4. Acanthamoeba does not depend upon a human host for the completion of its life cycle.

Yesterday’s Mind Teaser: Contact lens wear is proven to have deleterious effects on the corneal physiology which of the following statements is incorrect in connection with contact lens wear?

1. The level of glucose availability in the corneal epithelium is reduced.
2. There is a reduction in hemidesmosome density.
3. There is increased production of CO2 in the epithelium.
4. There is a reduction in glucose utilization by corneal epithelium.

Answer for Yesterday’s Mind Teaser: 4. There is a reduction in glucose utilization by corneal epithelium.

Correct answers received from: Dr Surendra Bahadur Mathur, Dr Priyanka Sharma, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay,

Answer for 31st July june Mind Teaser: 3. Accommodative inertia.
Correct answers received from: Dr.K.Raju, Dr.Kusum Surana, Dr Nikunj Garia

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr Prabha Sanghi)

A man and wife entered a dentist’s office. The wife said, "I want a tooth pulled. I don’t want gas or Novocain because I'm in a terrible hurry. Just pull the tooth as quickly as possible." You’re a brave woman said the dentist. Now, Show me which tooth it is. The wife turns to her husband and says, "Open your mouth and show the dentist. For comments and archives

    Drug Update

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

Drug Name
DCI Approval Date
Eslicarbazepine Acetate Tablets 200mg/400mg/600mg/800mg
As an adjunctive therapy in adults with partial-onset seizures with or without secondary generalisation.
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online (English/Hindi/Audio/Video/Photo)

What not to do in snake poisoning

In the monsoon season, snake bites are common. Most of these bites are by non–poisonous snakes. In a country like India, most people are misled by Bollywood movies showing a typical scene where the hero saves the heroine by giving an incision and then he sucks the poison and spits it out. "This is what should not be done", said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Dr. Aggarwal said that methods such as incision, oral sucking, mechanical sucking devices, cryotherapy, surgery and electric shock therapies have been widely used but are medically not recommended.

A common misconception depicted in the movies is that one should apply tourniquet, suck out the poison and spit it out. Medically, this approach is strongly discouraged as it can damage the nerves, tendons, blood vessels and lead to infections.

Venom removed by suction is minimal and clinically does not prevent snake bite complications. Many studies have shown that mechanical suction device reduces the total body venom burden by only 2%.

First aid involves removing the patient from the vicinity of the snake. Keep the patient warm, rested and reassured. The wound should be cleaned with soap and water. One should not give drugs and alcohol as it may confound with clinical assessment. Efforts should be made to identify the snake and the patient should be transported to the nearest medical facility as quickly as possible. For comments and archives

    Readers Responses
  1. Dear Sir eMedinews is really very informative and is just like “Gagar mai Sagar”. Regards: Dr  Anupam
    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.



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