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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


eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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  Editorial …

1st October 2011, Saturday

Do not give citalopram more than 40 mg

Doctors should not give citalopram at doses that exceed 40 mg per day because of dose–dependent QT interval prolongation.

The US FDA issued a safety alert in August 2011 that the antidepressant citalopram should no longer be used at doses exceeding 40 mg per day because higher doses have been associated with an increased risk for potentially fatal cardiac rhythm disturbances, including Torsade de Pointes.

In a randomized trial, the maximum mean corrected QT interval prolongation was greater in patients assigned to receive citalopram 60 mg per day compared with 20 mg per day.

No evidence is available that escitalopram causes dose–dependent QT prolongation. Other SSRIs can also cause QT prolongation, but are safe in usual recommended doses.

(FDA Drug Safety Communication: Abnormal heart rhythms associated with high doses of citalopram hydrobromide. http://www.fda.gov/Drugs/DrugSafety/ucm269086.htm)

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

Do not give citalopram more than 40 mg

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Divya Jyoti – An Inter Nursing School + College Health Festival

Nurses took active part in the competitions as a part of Perfect Health Mela.

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


In a first, Indian scientists sequence neem tree genome

For The first time ever, researchers in India have sequenced the entire genome of neem tree (Azadirachta Indica) in its entirety. A team of ten researchers at Ganit Labs — an integrated genomics lab in Bangalore set up earlier this year under a public–private partnership between Institute of Bioinformatics and Applied Biotechnology and Strand Life Sciences, a bioinformatics company — has successfully sequenced the genome of the plant known for its medicinal properties. "This is the first time the genome of a higher organism has been sequenced in India," the head of Ganit Labs Binay Panda told a press conference Thursday. Researchers in the US and elsewhere have sequenced genomes of several complex organisms but neem plant is not one of them. "We have traditionally known the medicinal properties of neem," Panda said. "Understanding its genetic complexity will help in developing agriculturally important compounds and pharmaceuticals. For instance, pesticidal compound Azadirachtin is found in neem seeds in wildly varying concentrations. With genetic understanding and engineering, Azadirachtin content in neem could potentially be increased and normalised." (Source: Indian Express, Sep 30 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)

FDA okays first face mask for kids

The FDA has cleared the first single–use face mask for preventing the spread of airborne pathogens that is made especially for children. The Kimberly–Clark Pediatric/Child Face Mask was designed to fit children from 5 to 12 years of age and does not resist air flow as strongly as an adult mask. "Children are not small adults. This pediatric face mask helps fill an unmet need for medical devices that are specifically designed for children’s unique anatomy and growing bodies," Susan Cummins, MD, of the FDA’s Center for Devices and Radiological Health said in a statement. (Source: Medpage Today)

For comments and archives

High–normal BP may raise stroke risk

Blood pressure at the higher end of the normal range––also called prehypertension––appears to be associated with a greater risk of stroke, a meta–analysis showed. In a pooled analysis of 12 studies, having a systolic pressure of 120 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg at baseline was associated with a 55% greater risk of incident stroke (RR 1.55, 95% CI 1.35 to 1.79), according to Bruce Ovbiagele, MD, of the University of California Los Angeles, and colleagues. The effect was mostly driven by an increased risk in patients in the higher range of prehypertension––a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg (RR 1.79, 95% CI 1.49 to 2.16), the researchers reported in the Oct. 4 issue of Neurology. (Source: Medpage Today)

For Comments and archives

Risk classification improves back pain outcomes

Classifying back pain patients according to risk of permanent disability and treating them accordingly led to better––and cheaper––outcomes than standard care, a U.K. randomized trial found. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Those who are lifting the world upward and onward are those who encourage more than criticize. ~ Elizabeth Harrison

@DeepakChopra: #CosmicConsciousness We dance around the ring and suppose. The secret sits in the middle and knows––Robert Frost

    Dr KK Answers

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

Which position is better for sex in heart patients?

There is no difference in heart rate (114 vs 117) or blood pressure (163/81 vs 161/77 mmHg) between man on top or man on bottom (1). However there is slightly lower minute oxygen consumption for men in the supine position, but this lasts only for a brief period during orgasm (2).


  1. Am Heart J 1976;92:274.
  2. Arch Intern Med 1984;144:1745.

For comments and archives

    Spiritual Update

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

Science behind 1st Navratri or Shailputri Worship

Navratri is the detoxification of body, mind and soul. Body detoxification involves Navratri diet containing eating less devoid of cereals. In Navratri diet flour is replaced with Kuttu or Singhara flour; pulses with amaranth or Rajgiri and Rice with Samak rice. Mental and soul detoxification involves practicing Yoga Sadhna as described in nine forms of Durga.

For comments and archives

    An Inspirational Story

(Dr Anil Kumar Jain)

Aruni of Panchala was a dedicated student of the ancient sage Dhoumya. In the days of yore, a student had to stay with the teacher and help in the teacher’s daily chores in order to receive the knowledge he sought. It was a day of cold winter. Aruni was carrying the firewood he had collected for the sage’s household. As he was passing by a field, which belonged to the sage, he noticed a breach in the embankment that was holding water in his teacher’s field. He realized that the water would seep away and the field’s crops would die with no water.

"What should I do? If I stop to build the embankment I will be delayed and there is no firewood at the hermitage to keep the place warm. I better rush to the hermitage with the firewood and then come back to take care of the breach." Meanwhile the sage and his disciples had assembled for the day’s lesson. Aruni was missing.

Soon Aruni rushed in, dropped the firewood in the courtyard, and informed the teacher about the breach of the embankment. Then he quickly rushed out. Sage Dhoumya felt proud of his disciple, "It is hard to get such a responsible disciple."

Aruni ran all the way back to the troubled spot and tried to stop the leakage of water by putting some logs and mud. However, this did not stop the leak. The heavy pressure of water washed away the dam Aruni made. He felt helpless. It seemed impossible for him to stop the leakage without help. He thought for a while and then made a plan.

It was getting dark and the teacher became worried. He called his disciples and set out looking for Aruni. As he called out for Aruni, he heard a faint voice, "Here I am master!" The teacher and his disciples rushed to the spot and saw Aruni lying on the breach, in order to hold the water in the field. The disciples quickly pulled Aruni out from the freezing water. He was repeatedly muttering, "The water is flowing out, the crops will die."

"Don’t worry Aruni! We will take care of the breach," said the disciples. "Never mind my son! You are more precious than the crop," said the teacher.

Aruni was covered in a blanket and brought home. Sage Dhoumya himself tended to Aruni. The sage then blessed his disciple with pride, "You shall, forever, be renowned for your unmatched devotion and obedience to your guru.

For comments and archives

  Fitness Update

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

Brain’s Reward Centers Demand Glucose

If the brain goes hungry, Twinkies look a lot better, a study led by researchers at Yale University and the University of Southern California has found. Brain imaging scans show that when glucose levels drop, an area of the brain known to regulate emotions and impulses loses the ability to dampen desire for high–calorie food, according to the study published online in The Journal of Clinical Investigation.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

A patient was seen in the OPD by a third year PG Resident, who admitted him in the ward. The patient was treated and discharged. Later, due to certain facts emerging, the police wants a medico–legal case report. Who should give such a report:

a. The Resident?
b. The Unit Head under whom the resident worked?


  1. This case is unlike an ordinary police case that is seen in the casualty and the MLC is prepared and a copy given to the police. In such a case, the MLC is to be prepared by the doctor who has first examined the patient.
  2. In this case the patient has been treated and discharged and the criminal circumstances have come to light later on. It will be improper to register this case in the regular MLC register and to prepare a regular MLC report and give a copy to the police in the usual manner.
  3. If the police later sends a request to the Medical Superintendent to give a medical report for legal purposes, he should comply with it in the following manner:
    • He should instruct the Medical Records Officer to label the records as "Legal" and to keep them in safe custody.
    • He should form a committee headed by the HOD. The Committee should also include the unit head and the resident and a faculty from the Forensic Medicine Department. The Committee may co–opt anybody else as necessary. The committee should draft a reply for the police. The reply should be signed by all the members mentioned and endorsed by the medical superintendent. If the police wants, a copy of the case sheet may also be supplied.
    • The Medical Superintendent should keep track of the resident if he leaves the hospital so that his whereabouts may be informed to the police if they need the same later

For comments and archives

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    Malaria Update

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

How is malaria diagnosed?

If a microscopy result cannot be made available within 24 hours in Pf predominant areas, RDT should be used for diagnosis, which is simple and can be done by any healthcare providers in their clinic. If the RDT is found negative, then the slide is to be sent for microscopy. If it is positive, the patient is treated for falciparum malaria. Mixed infection cannot be ruled out in such cases, but the risk is low.

For comments and archives

    Medicine Update

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

What is acute liver failure?

Acute liver failure is defined as severe functional impairment of hepatocytes with no pre–existing liver disease, with coagulopathy not corrected by vitamin K.

  • INR >1.5 + encephalopathy
  • INR >2 ± encephalopathy

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

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 Chairperson–Dr Kaberi Banerjee

Day–1 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 to rule out other causes of diarrhea and inflammation

  • Stool culture to look for bacterial infection
  • O&P (Ova and parasites) to detect parasites
  • Clostridium difficile to detect toxin created by bacterial infection; may be seen following antibiotic therapy
  • Fecal occult blood to look for blood in the stool
  • Celiac disease tests

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with sleep apnea wanted to know his risk of stroke.
Dr. Bad: There is no risk.
Dr. Good: There is increased risk.
Lesson: Evidence is accumulating that obstructive sleep apnea increases the risk of stroke.

For comments and archives

Make Sure

Situation: A patient with acute fever developed acute bleeding after aspirin was given.
Reaction: Oh my God! Why was dengue not ruled out?
Lesson: Make sure that all patients with acute febrile illness are evaluated for dengue as low platelets count can precipitate bleeding in them, if aspirin is given to reduce fever.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all. Dale Carnegie


Method to my madness: Strange or crazy actions that appear meaningless but in the end are done for a good reason.

  Rabies Update

(Dr A K Gupta, R. P. Bagh, Delhi, Author of "RABIES–the worst death")

Can the wound be deepened for cleaning purpose?

We should never try to deepen the bite wound by cutting it further to bleed and then clean the wound.

Can local antibiotics or antimicrobial agents be applied on the site of bite?

Yes. After cleansing of the bite wounds, local antimicrobial agents can be applied. Discourage local wound applicants like turmeric, neem, red chilli, lime, plant juices, coffee powder etc.

What should be done with severe animal bite wounds that would, with most other types of injury, be closed by primary suture?

If possible, avoid suturing of the bite wound since it may risk inoculation of the virus deeply into the wound. However, if the wound has to be sutured, it should be done after infiltration of RIGs into and around wounds. Any surgical manipulations of possibly rabies–infected animal bite wounds increase the risk of death.

For comments and archives

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

(Dr Anupam Sethi Malhotra)

He is a true friend who does not forsake us in time of need, misfortune, famine, or war, in a king’s court, or at the crematorium (smasana).

    Medicolegal Update

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

Post–mortem suggests the majority of fatal stab wounds are on the chest

  • The doctor conducting the postmortem examination must keep in mind that the shape and size of the wound suggests the width and type of weapon whether it is single edged or otherwise, the depth of the wound will indicate the length of weapon, the directions and dimensions of the wound indicate the relative position of the assailant and the victim, and the position, direction and number of wound may indicate manner of production, i.e., suicide, accident or homicide.
  • The medico–legal postmortem of 29 cases of death due to stab wound has been conducted by me in the year 2010 brought from south Delhi
  • A stab wound is produced from penetration by long narrow instruments with blunt or pointed ends such as knife, dagger, nail, needle, spear, arrow, screw driver etc. into the depths of the body, penetrating the skin and the underlying tissues that is deeper than its length and width on skin.
  • This is caused by driving the object into the body or from the body’s pressing or falling against the object and object penetrate due to body momentum.
  • The wound is called punctured wounds when it enter a body cavity one way only however when the weapon enters the body on one side and comes out from the other side, it is called perforating wound.
  • The wound of entry is larger and the wound of exit is smaller due to tapering of the blade in stab wound which is contrary to fire arm missile entry and exit wounds.
  • The doctor must preserve for police if a broken fragment of weapon is found, it will identify the weapon or connect the accused person with the crime.
  • Death due to sharp force violence is most common cause of homicide in India also in the many other parts of Europe, as well as in Africa and Asia. It also accounts for 30% of fatal and non–fatal family assaults in the USA

For comments and archives

    Mind Teaser

Read this…………………

Johnny’s mother had three children. The first child was named April. The second child was named May. What was the third child’s name?

Yesterday’s Mind Teaser: Involvement of which of the following organ is likely to be associated with poor outcome in primary amyloidosis

a. Cardiac
b. Renal
c. Skin
d. Liver

Answer for Yesterday’s Mind Teaser: a. Cardiac

Correct answers received from: Dr Anil Kumar Jain, Dr Gita Arora, Dr Prabha Luhadia, Dr Chandresh Jardosh, Dr K Raju, Dr Anupam, Dr Naveen, Dr Piyush, Dr Krish.

Answer for 29th September Mind Teaser: 3. Axillary lymph node assessment is important to guide adjuvant therapy.
Correct answers received from: Dr Jainendra Upadhyay, Dr Arun, Dr Rishabh, Dr Sorya, Dr Kastur,
Dr Tushar, Dr Prabhat.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Veena Aggarwal)

Murphy’s Laws for Humour

Alcohol doesn’t solve any problems, but if you think again, neither does Milk.

    Public Forum

(Press Release for use by the newspapers)

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

Be cautious in giving pain killer to patients with high cholesterol

One should not give long term non–steroidal anti–inflammatory painkiller drugs such as naproxen to patients with high cholesterol 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.

In a swine model study published in Surgery Dr Frank Sellke, chief of cardiothoracic surgery and research at Rhode Island Hospital found that a high–cholesterol diet reduced blood flow to the heart muscle in animal models with chronic heart disease when given daily naproxen. They also found reduced levels of prostacyclin, a compound that dilates blood vessels and prevents blood clots.

These findings suggest that there may be a stronger risk of negative effects on the heart in patients who have high cholesterol levels and are taking NSAIDs as a form of pain or inflammation relief.

For comments and archives

    Readers Response
  1. Sir, Thank you very much for covering malaria in eMedinews. Looking for similar support in future. With regards. Regards: Dr AC Dhariwal.
    Forthcoming Events

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

Dr K K Aggarwal

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    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

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

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  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    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