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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

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eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

3rd March 2013, Sunday

Cycling can cause erectile dysfunction?

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hrs a week can cause erectile dysfunction in males. For those who drive cycles for more than 3 hours a week should do so in reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate.Surgery or priapism may cause erectile dysfunction.

Bicycling —Less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling induced impotence, is primarily a problem of serious cyclists and is reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than three hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting ten minutes.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What is the role of lactulose in constipation?

Lactulose increases stool frequency, decreases the severity of constipation symptoms and reduces the need for other laxatives in older adult patients. However, in one study, lactulose was less effective than low–dose polyethylene glycol (PEG) and also had a higher incidence of flatus (Gut 1999;44(2):226–30). In another study, PEG 3350 compared with lactulose provided a higher success rate with fewer side effects (Gut 2004 Nov;53(11):1590–4).

For comments and archives

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Ventilator-associated tracheobronchitis

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Multi-specialty camp in East Delhi

A multispecialty camp was organized by Heart Care Foundation of India in association with East Delhi Walkers’ Association on 17th February 2013.

Dr K K Aggarwal
    National News

IMA Warangal to have emergency general body meeting

Sunday 3rd March IMA Warangal will have an emergency AGM to protest against the barbarous act by PNDT  team at Tejaswi Hospital. This was 26th Feb when a gynecologist saved the mother with IUD of eleven weeks.  The case came to the gynecologist with a confirmed IUD report from independent sonologist working in government set up. The patient was already seen by another gynecologist and advised the same treatment. The media carried negative story without taking the confirmation from the treating doctor or the patient.

IMA State President Dr P V C Reddy said that such types of incidences are against the interest of the medical profession. False cases against doctors can spoil the image of the professionals. No media should cover the report without a preliminary enquiry and only when a prima false case exists against the doctors.

National President IMA Dr K Vijaykumar said that the concerned media and the PNDT team must unconditionally apologize for the incidence.

Let us all unite together to condemn such instances.

Rise in cancer deaths in India: Minister

India has seen a steady increase in the number of deaths due to cancer, Health Minister Ghulam Nabi Azad has told the Rajya Sabha. "There has been an increase in the number of cancer deaths. Information received from Indian Council of Medical Research (ICMR) suggests that estimated number of cancer cases is increasing," Azad said in a statement in the house this week. The three-year consolidated report of the national cancer registry programme of ICMR for 2006-08 shows an increase in average number of cases in different regions as compared to the previous report of 2004-05, he said. "While no formal study has been undertaken by the ministry for the reasons of increase in number of cancer cases, this may be attributed to ageing population, unhealthy life styles, use of tobacco and tobacco products," Azad said, replying to a question by MPs H.K. Dua and Gundu Sudharani. Azad said the government was aware of the study carried out by the Punjab government that at least 33,000 people have died of cancer in the state during the last five years. The national cancer registry programme of ICMR initiated a project on 'Development of an Atlas of Cancer in Punjab State' in March 2011 to find whether the incidents of cancer are high in Punjab, in particular, and in any specific region or regions of the state, he said. While health is a state subject, Azad said, the central government has supplemented the efforts of state governments in prevention, early detection and management of cancer cases. It has launched a comprehensive National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010 in 100 districts across 21 States. Under the programme, financial assistance up to Rs.1 lakh per patient is provided for chemotherapy drugs to treat 100 cancer patients per district. The central government also supplements the efforts of the state governments by focusing on early detection of cancer, promoting health education and creating awareness. The programme also envisages strengthening government medical college hospitals; regional cancer centres (RCC) across the country will be now designated tertiary cancer centres (TCC) for providing comprehensive cancer care services. These institutions are eligible for financial assistance up to Rs.6 crore. (Source: The Pioneer, 01 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)


Child maltreatment is defined as unintentional harm or threat or harm to a child by a person who is acting in the role of caretaker. The caretaker means parents or an employee of a residential facility or any staff/person providing out of home care.

For comments and archives

    Valvular Heart Disease Update

When is antithrombotic therapy indicated after heart valve replacement?

Treatment with warfarin (or other vitamin K antagonist) and/or aspirin is recommended in patients with prosthetic heart valves to prevent valve thrombosis and thromboembolic events.

(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)

    From the Desk of Vice President (Elect) IMA (Dr KK Aggarwal)

Can you operate without consent?

Can you do transplant in a set-up without permission?

The Ethics Committee considered the appeal filed by Sh. Pankaj Rai against the order dated 02.06.2011 (F. No. 102/2011) passed by Karnataka Medical Council and after deliberating on the matter at length, the Committee is of the view that in this case the treating surgeon namely Dr. Ramcharan Thiagarajan, Fortis Hospital, Bangalore operated in the hospital which was not possessing valid permission issued by Competent Authority for conducting the surgery for pancreas transplant and failed to take proper informed consent for the entire procedure of kidney and pancreas transplant surgery. Therefore, the Ethics Committee found that Dr. Ram Charan Thiagarajan had violated the Indian Medical Council Regulations, especially Clause 7.16 and the hospital authorities were found to be working illegally as they could not prevent pancreatic transplant surgery in their hospital, as they did not possess any valid permission to do so.

MCI code of ethics: 7.16 “Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may”

In view of the above, the Committee decided to impose the following punishment: The name of Dr. Ram Charan Thiagarajan be struck off from the Indian Medical Register as well as from the Register of State Medical Council for a period of One (01) Year.

The Fortis hospital is found to have performed pancreatic transplant surgery without valid permission from the competent authority. The Govt. of Karnataka (Principal Secretary, Health and Family Welfare) is requested to take suitable action against the hospital management for conducting pancreatic transplant surgery without valid permission to do so."

Ms. Rai underwent kidney and pancreas transplant procedures on May 2, 2010, and died four days later of septic shock. Maj. Rai alleged that the hospital had neither taken his consent for the pancreas transplant nor did it have the licence to do the complicated procedure.

Although Maj. Rai had complained to the Karnataka Medical Council (KMC), it gave a clean chit to the hospital and the surgeon in June 2011. The bereaved husband then moved the MCI against the KMC order.

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Fatal MI more likely after sibling dies

The death of an adult brother or sister may boost one's own risk of dying from a heart attack in the following years, a population-based study showed. (Source: Medpage Today)

Blood culture medium affects bacterial detection, recovery

The choice of which blood culture medium to use in detecting possible sepsis in trauma and emergency patients can make a difference in time to bacterial detection and recovery, according to an article published in the March 15 issue of Clinical Infectious Diseases. (Source: Medscape)

Asthma drug curbs chronic hives

Symptoms of chronic idiopathic urticaria, or hives, in adults that did not respond to antihistamines were significantly reduced with omalizumab (Xolair), according to results of a phase III trial presented at the American Academy of Allergy, Asthma, and Immunology's annual meeting. (Source: Medpage Today)

Rheumatologists name 5 tests to reconsider

Testing antinuclear antibody (ANA) subserologies without a positive ANA screen, Lyme disease testing without exposure history and large-joint arthralgia, peripheral joint magnetic resonance imaging (MRI) for routine monitoring for rheumatoid arthritis (RA), biologics for RA without a trial of methotrexate, and dual-energy X-ray absorptiometry (DXA) more frequently than every 2 years all made the American College of Rheumatology's top 5 list of things physicians and patients should question, published in the March issue of Arthritis Care & Research. (Source: Medscape)

Six factors best predict Afib risk in women

Researchers have devised a simple method for determining 10-year atrial fibrillation (Afib) risk in women, and the method gained very little when combined with genetic risk markers. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Mobile phones can spread infections in the hospital Mobile phones used by hospital healthcare workers are often... http://fb.me/1DGpsASYk

@DeepakChopra: The Conscious Lifestyle: A Leader Must Know What to Do (Part 2)http://www.linkedin.com/today/post/article/20130302005406-75054000-the-conscious-lifestyle-a-leader-must-know-what-to-do-part-2 …

    Spiritual Update

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

Why do over 10 crore people visit Kumbh Maagh Mela?

Maagh Mela is one of the largest gatherings of the world in one month’s time at one place. Over 10 crore people visit the Maha Kumbh Mela ( every twelve years) while 6-8 crore visit the Ardh Kumbh Mela which happens every six years around one crore people visit annual Maagh Mela.

For comments and archives

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

What precautions should be taken while carrying a multiple pregnancy?

Metabolic and nutritional considerations: There is an increased need for maternal nutrition in multiple pregnancies. An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. In multiple pregnancies, a weight gain of approximately 45 pounds is optimal for normal weight women. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.

Activity precautions: Women with multiple pregnancies are usually advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may increase birth weight up to 20%. Intercourse is generally discouraged when bed rest is recommended.

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

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

Whole blood


  • Chronic anemia
  • Incipient cardiac failure

Dosage: One unit of whole blood increases hemoglobin by 0.75 to 1 gm/dl and hematocrit by 3–5%.


  • Must be ABO and RhD compatible with the recipient
  • Never add medications to the unit of blood
  • Complete transfusion within 4 hours of commencement
    An Inspirational Story

A couple’s heartbreak

A boy was born to a couple after eleven years of marriage. They were a loving couple and the boy was the apple of their eyes.

One morning, when the boy was around two years old, the husband saw a medicine bottle open. He was late for work so he asked the wife to cap the bottle and put it in the cupboard. The mother, preoccupied in the kitchen, totally forgot the matter.

The boy saw the bottle and playfully went to it and, fascinated with its color, drank it all. It happened to be a poisonous medicine meant for adults in small dosages. When the child collapsed, the mother hurried him to the hospital, where he died. The mother was stunned; she was terrified. How would she face her husband?

When the distraught father came to the hospital and saw the dead child, he looked at his wife and uttered just four words. “I Love You Darling.”

The husband’s totally unexpected reaction is proactive behavior. The child is dead. He can never be brought back to life. There is no point in finding fault with the mother. Besides, if only he have taken time to put the bottle away, this would not have happened.

No point in attaching blame. She had also lost her only child. What she needed at that moment was consolation and sympathy from the husband. That is what he gave her. Sometimes we spend time asking who is responsible or who’s to blame, whether in a relationship, in a job or with the people we know and miss out on the warmth in human relationships we could receive by giving each other support.

After all, shouldn’t forgiving someone we love be the easiest thing in the world to do? Treasure what you have. Don’t multiply pain, anguish and suffering by holding onto forgiveness. Let go of all your envies, jealousies, unwillingness to forgive, selfishness, and fears and you will find things are actually not as difficult as you think.

If everyone could look at life with this kind of perspective, there would be fewer problems in the world.

For comments and archives

    Cardiology eMedinewS

Availability of sugar may impact a country's diabetes rate Read More

Cholesterol trial shut down Read More

    Pediatric eMedinewS

Ondansetron safe for fetus, study affirms Read More

Cinacalcet trials halted due to pediatric death 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)

What are the various types of modern anti-rabies vaccines?

These are:

  • Purified vero cell rabies vaccine (PVRV)
  • Purified chick embryo cell vaccine (PCECV)
  • Human diploid cell vaccine (HDCV)
  • Purified duck embryo vaccine (PDEV)
    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and also stop low dose aspirin.
Lesson: In dengue, low dose aspirin should be discontinued.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

    Quote of the Day (Dr GM Singh)

A good way to change someone's attitude is to change your own. Because, the same sun that melts butter, also hardens clay! Life is as we think, so think beautifully.

    Mind Teaser

Read this…………………

Which is the most effective method for teaching strengthening exercises to patients with chronic pain?

1. Distributing a local listing of strengthening exercise classes
2. Providing demonstration and return demonstration
3. Providing handouts with pictures
4. Viewing a self-instruction video

Yesterday’s Mind Teaser: The pain management nurse assesses a 67-year-old patient for reports of episodic, sudden-onset, and right-sided facial pain. The patient describes the pain as fleeting, electric-like, and triggered by light touch and brushing of the teeth. The pain management nurse suspects:

a. Facet syndrome.
b. Myofascial pain syndrome.
c. Temporomandibular disorder.
d. Trigeminal neuralgia.

Answer for Yesterday’s Mind Teaser: d. Trigeminal neuralgia.

Correct answers received from: Dr BK Agarwal, Dr Anupam Sethi Malhotra,
Dr Suresh Arora, Dr Shashi Saini, Dr Pankaj Agarwal, Dr PC Das,
Dr Raghavendra Jayesh, Dr Jainendra Upadhyay, Dr Jayashree Sen & Dr Bitaan Sen, Dr Jella, Dr KV Sarma, Dr Arpan Gandhi, Dr Chandresh Jardosh, Dr Prabha, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai Dr PK Sahu, Dr Kanta Jain, Dr Avtar Krishan, Dr Valluri Ramarao.

Answer for 1st March Mind Teaser: Clarify the patient's report by reviewing the patient's nonverbal behavior.

Correct answers received from: Dr Jainendra Upadhyay, Dr Jella,
Dr KV Sarma, Dr Chandresh Jardosh, Dr Prabha, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai Dr PK Sahu, Dr Kanta Jain, Dr Avtar Krishan, Dr Valluri Ramarao.

Send your answer to ijcp12@gmail.com

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   Laugh a While (Dr Vasant)

Gujju Special

Bill Gates organized an enormous session to recruit a new Chairman for Microsoft Europe. 5000 candidates assembled in a large room. One candidate is Mr. Patel.

Bill Gates: Thank you for coming. Those who do not know JAVA may leave.

2000 people leave the room. Mr. Patel says to himself, 'I do not know JAVA but I have nothing to lose if I stay. I'll give it a try'

Bill Gates: Candidates who never had experience of managing more than 100 people may leave.

2000 people leave the room. Mr. Patel says to himself ' I never managed anybody by myself but I have nothing to lose if I stay. What can happen to me?' So he stays.....

Bill Gates: Candidates who do not have management diplomas may leave.

500 people leave the room. Mr. Patel says to himself, 'I left school at 15 but what have I got to lose?' So he stays in the room...

Finally, Bill Gates asks the candidates who do not speak Serbo - Croat to leave.

498 people leave the room. Mr. Patel says to himself, ' I do not speak one word of Serbo - Croat but what do I have to lose?'

So he stays and finds himself with one other candidate. Everyone else has gone. Bill Gates joined them and says "Apparently, you are the only two candidates who speak Serbo - Croat, so I'd now like to hear you have a conversation together in that language."

Calmly, Mr. Patel turns to the other candidate and says, "Kem chho?"

The other candidate answers "Ekdam majaa maa!!"

    Medicolegal Update

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

Medical fasting

  • Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established
  • The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
  • Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
  • Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
  • In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Passive smoking can cause dementia

People exposed to secondhand smoke may face as much as a 44 percent increased risk of developing dementia, said Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Smoking is already known to increase the risk for dementia and Alzheimer's disease, said Dr Vinit Suri Sr. Neurologist at Apollo Hospital Delhi.

A study from Peninsula Medical School in Exeter, England published in the journal BMJ has shown that there is an association between cognitive function and exposure to passive smoking. The risk increases with the amount of exposure to secondhand smoke. For people at the highest levels of exposure, the risk is probably higher.

The study collected data on more than 4,800 nonsmokers who were over 50 years old and tested saliva samples from these people for levels of cotinine, a product of nicotine that can be found in saliva for about 25 hours after exposure to smoke. The researchers found that people with the highest cotinine levels had a 44 percent increased risk of cognitive impairment, compared with people with the lowest cotinine levels. And, while the risk of impairment was lower in people with lower cotinine levels, the risk was still significant.

Passive smoking is also associated with an increased risk of stroke and heart disease, added Dr Praveen Chandra from Medanta - The Medicity.

    Readers Responses
  1. Dear All, There is nothing in the present union budget to promote the private health care providers and their institutions though they are the major players in the system, especially in the rural areas. Govt always cries about strengthening rural health care sector. Union Govt always shows extreme eagerness to interfere in the state matter of health through weird policies and schemes, but does nothing creative…..Regards: Dr. Sushma Anil.
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