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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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  Editorial …

3rd April 2013, Wednesday

What’s new in Gynecology?

  • Use of selective serotonin reuptake inhibitors (SSRIs) to treat pregnant patients does not appear to be associated with stillbirth or infant mortality (1).
  • The United States Advisory Committee on Immunization Practices (ACIP) recommended that all pregnant women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, optimally between 27 and 36 weeks of gestation, regardless of prior vaccination status, to increase the likelihood of optimal protection against pertussis for both the mother and her infant during the first few months of the infant’s life (2). Previously, Tdap was recommended only for pregnant women who had not previously received the acellular pertussis vaccine during adulthood.
  • Vaccination during pregnancy substantially reduced the risk of a maternal influenza diagnosis (adjusted hazard ratio, 0.30) and was associated with a trend in reduction of fetal death. All women who are pregnant or will be pregnant during influenza season should receive the inactivated influenza vaccine, regardless of pregnancy trimester (3).
  • A December 2012 American College of Obstetricians and Gynecologists (ACOG) committee opinion concluded that the decision to perform early versus delayed cord clamping in term deliveries should be based on patient-specific factors, particularly the infant’s risk of developing iron deficiency anemia (4). For preterm deliveries, they recommended delayed cord clamping given the significant reduction in intraventricular hemorrhage associated with this intervention (3).
  • In a prospective study of mothers who used benzodiazepines (primarily lorazepam, clonazepam, and midazolam) while breastfeeding, central nervous system depression (defined as sleepiness, poor latching, limpness, or lack of response to stimuli) in infants was an infrequent finding (affecting 2 out of 124, or 1.6 percent) (5).


  1. Stephansson O, Kieler H, Haglund B, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of stillbirth and infant mortality. JAMA 2013;309:48.
  2. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm?s_cid=mm6207a4_e (Accessed on February 21, 2013).
  3. Håberg SE, Trogstad L, Gunnes N, et al. Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med 2013;368:333.
  4. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012;8:CD003248.
  5. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr 2012;161:448.

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Dr KK Aggarwal
Group Editor in Chief

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Weight loss may improve sexual health of obese diabetes

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Dr KK Aggarwal in an interview with IBN7 on Kejriwal fasting

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    National News

TB, diabetes make for grim combo: experts call for treatment protocol

CHENNAI: In 600 A.D., Indian physician Sushruta had said there was an association between two deadly diseases — tuberculosis and diabetes. Today, with this association having become a dangerous reality, doctors say the need of the hour is to develop a treatment protocol for patients who have both TB and diabetes. “When patients with tuberculosis get diabetes, there is almost no sign of it. When we followed TB patients who had diabetes, we found that their treatment for TB was failing, leading to a delay in their recovery. There is an urgent need now to screen all TB patients for diabetes. The government already screens pregnant women for diabetes, and this needs to be extended to those with TB as well,” said Vijay Viswanathan, head and chief diabetologist, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre. Not treating diabetes could have severe outcomes on the treatment of TB, including an increased risk of recurrent TB, he said. Conversely, diabetics are also more vulnerable to TB. “They have a three times higher risk of contracting TB, as diabetes affects their innate and adaptive immunity,” said Soumya Swaminathan, director of the National Institute for Research in Tuberculosis.
Sometime ago, the Tuberculosis Research Centre conducted a study among 100 TB patients — 50 of whom had diabetes and 50 of those who didn’t. “The study found excellent TB treatment outcomes when diabetes was controlled and closely monitored. There was the same cure rate and low recurrence rate,” she observed. The emphasis now is on developing a protocol to treat people with diabetes and TB, said health secretary, J. Radhakrishnan. “We already have a standard treatment protocol for TB and for Multi-drug-resistant (MDR) TB. With diabetes, there may be added complications and treatment may take longer. The focus should be on case management — every TB patient should be tested for diabetes and every diabetic with symptoms of cough should be tested for TB,” he said. The discussion on the dual burden of diabetes and TB – a consensus on treating coexisting diseases, was jointly organised by Primary Health Care Intervention Research and Education- ASPIRE and M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre. (Source: The Hindu, April 1, 2013)

For comments and archives

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)


All about child sexual abuse

  1. Sexual abuse occurs primarily in preadolescent children.
  2. It’s more often in girls.
  3. Perpetrators are usually males.
  4. They are known to the victims.
  5. Most of the complaints that are possible indicators of sexual abuse are nonspecific.

For comments and archives

    Valvular Heart Disease Update

What are the most common causes of significant mitral regurgitation in the elderly?

The causes are mitral valve prolapse and ischemic heart disease.

Surgery for severe chronic mitral regurgitation is recommended for young asymptomatic patients with early evidence of left ventricular dysfunction but the same is not indicated in patients over age 80 to proceed with surgery unless symptomatic.

(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)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Stress varies in parents of kids with cancer

Parents of children with advanced cancer are likely to have high levels of psychological distress, but just how high hinges on a number of variables, some clinical, some economic, researchers reported. (Source: Medpage Today)

For comments and archives

Urine biomarker combo predicts prostate cancer

A combination of 2 urine-based genetic biomarkers predicts prostate cancer better than either biomarker alone and better than the standard serum prostate-specific antigen (PSA), according to a new study. (Source: Medscape)

For comments and archives

MI risk drops with post-ED angina care

After an emergency visit for chest pain, high-risk patients who seek prompt follow-up care fare better, researchers found. (Source: Medpage Today)

For comments and archives

Statin discontinuation common, but patients can be rechallenged to try again

Nearly one in five patients treated with a statin in a routine-care setting had a statin-related adverse event documented, the most common of which was myalgia or myopathy, and more than half of these patients stopped taking the medication at least temporarily, according to the results of a new analysis. (Source: Medscape)

For comments and archives

Heart, stroke prediction tools predict dementia

Standard risk prediction tools for heart disease and stroke are better at predicting declining mental powers than a specific dementia risk score, researchers reported. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Air Pollution may Raise Risk of Stroke, Cognitive Decline

@DrKKAggarwal: Being healthy is more than eating right. @MallikaChopra & friends talk about healthy living 4 kids on #PIP http://tinyurl.com/d9s8dsk

    Spiritual Update

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

Sacrifice a goat and clear the board exam : Its scientific

“Students in tribal-dominated Jhabua district in Madhya Pradesh and adjoining villages in Gujarat believe that sacrificing got can make them pass an exam. Ranapur, 45 km from Jhabua, an idol of Baba Dongar, a tribal god is making all wishes come true. Here, photocopies of exam admit cards are tied around trees and in return for their entreaties coming true, the supplicants promise to offer the god a goat, a hen or a bottle of liquor. Some 500 animals are sacrificed here every day and there are more than a dozen such priests who do the slaughtering.”

For comments and archives

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

How is the recipient couple evaluated?

The physician should obtain a comprehensive medical history from both partners. In addition, the female assessment will include a comprehensive gynecologic history and complete physical exam. From a laboratory perspective, the female should have an assessment of ovarian reserve, when appropriate, with at minimum, a measurement of day 3 follicle–stimulating hormone (FSH) blood levels, blood type and Rh, and rubella and CMV. A Pap smear and cultures for Neisseria gonorrhea and Chlamydia trachomatis should be obtained. The female partner should have an evaluation of her uterine cavity with a hysterosalpingogram (HSG), sonohysterogram (SHG), or hysteroscopy. If the female recipient is over the age of 45 years, a more thorough evaluation with assessment of cardiac function, risk for pregnancy–induced hypertension and gestational diabetes should be considered. The male assessment will include a semen analysis. The intended recipient couple should be screened for syphilis, hepatitis B and C, HIV–1 and HIV–2.

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

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

Transfusion practices in general medicine

  • The decision to transfuse should be guided by the clinical situation, and not only by laboratory reports.
  • Do not add any medication to the unit of blood.
  • Do not transfuse more than required to tide over a crisis. Restoring hemoglobin to normal value is not necessary.
  • Rate of transfusion should not exceed 2–4 ml/kg/hour (except in emergency or massive transfusion.)
  • Transfusion cannot correct cause or non hematologic effects of the underlying pathology.
  • Avoid volume overload in patients with incipient cardiac failure.
  • Avoid transfusion from first degree relatives to prevent transfusion–associated graft versus host disease (TA–GvHD).
  • Single unit transfusions are not recommended. However, it is important to identify situations where more than one unit may harm the patients. (e.g. Low cardiac output)

For comments and archives

    An Inspirational Story

Teamwork Lesson

When you see geese flying along in "V" formation, you might consider what science has discovered as to why they fly that way. As each bird flaps its wings, it creates an uplift for the bird immediately following. By flying in "V" formation, the whole flock adds at least 71 percent greater flying range than if each bird flew on its own. People who share a common direction and sense of community can get where they are going more quickly and easily because they are traveling on the thrust of one another.

When a goose falls out of formation, it suddenly feels the drag and resistance of trying to go it alone – and quickly gets back into formation to take advantage of the lifting power of the bird in front. If we have as much sense as a goose, we will stay in formation with those people who are headed the same way we are.

When the head goose gets tired, it rotates back in the wing and another goose flies point. It is sensible to take turns doing demanding jobs, whether with people or with geese flying south. Geese honk from behind to encourage those up front to keep up their speed.

What messages do we give when we honk from behind? Finally – and this is important – when a goose gets sick or is wounded by gunshot, and falls out of formation, two other geese fall out with that goose and follow it down to lend help and protection. They stay with the fallen goose until it is able to fly or until it dies, and only then do they launch out on their own, or with another formation to catch up with their group.

If we have the sense of a goose, we will stand by each other like that.

For comments and archives

    Cardiology eMedinewS

Training in Schools Could Reduce Sudden Cardiac Arrest Fatalities
Read More

High Fiber Diet Protects You from Stroke Read More

    Pediatric eMedinewS

Prebiotics may guard against infant eczema 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 is the “potency’ of rabies vaccine?

WHO recommends that the vaccine potency should be at least 2.5 IU per dose. The potency is the capacity of the vaccine to induce immune response.

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady developed hypotension with respiratory distress immediately after delivery.
Dr Bad: This is an internal bleed.
Dr Good: It looks like AFES.
Lesson: Amniotic fluid embolism syndrome (AFES) is a catastrophic condition that occurs during pregnancy or shortly after delivery. It is characterized by the abrupt and fulminant onset of hypotension due to cardiogenic shock, hypoxemia, respiratory failure, and disseminated intravascular coagulation. Clinicians should suspect AFES whenever shock or respiratory compromise develops during labor and delivery, or immediately postpartum. Other causes of sudden intrapartum or postpartum cardiorespiratory failure must be excluded.

Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

  Quote of the Day (Dr GM Singh)

A total commitment is paramount to reaching the ultimate in performance Tom Flores

    Mind Teaser

Read this…………………

Nurse Claudine is reviewing a client’s fluid intake and output record. Fluid intake and urine output should relate in which way?

a. Fluid intake should be double the urine output.
b. Fluid intake should be approximately equal to the urine output.
c. Fluid intake should be half the urine output.
d. Fluid intake should be inversely proportional to the urine output.

Yesterday’s Mind Teaser: An infant, 6 weeks old, is brought to the clinic for a well-baby visit. To assess the fontanels, how should Nurse Oliver position the infant?

a. Supine
b. Prone
c. In the left lateral position
d. Seated upright

Answer for yesterday’s Mind Teaser: d. Seated upright

Correct answers received from: Tukaram Pagad, Dr Suresh Arora, Dr BB Gupta, Dr KV Sarma, Dr Gajveer, Dr Arpan Gandhi, Dr Ayyavoo, Dr Pankaj Agarwal, Dr K Raju, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai, Dr BK Agarwal, Dr K Raju.

Answer for 1st April Mind Teaser: d. Assessing present elimination patterns of erythropoietin.

Correct answers received from: Prabha Sanghi, Dr BK Agarwal, Dr K Raju.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

21st Century Marriage

I stopped at a florist shop after work to pick up roses for my wife.

As the clerk was putting the finishing touches on the bouquet, a young man burst through the door, breathlessly requesting a dozen red roses.

"I'm sorry," the clerk said. "This man just ordered our last bunch."

The desperate customer turned to me and begged, "May I please have those roses?"

"What happened?" I asked. "Did you forget your wedding anniversary?"

"It's even worse than that," he confided. "I crashed my wife's hard drive!"

    Medicolegal Update

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

What is Touch DNA?

Locard’s Exchange Principle states that with contact between two items, there will always be an exchange. So, when a crime is committed, if the perpetrator deposits a sufficient number of skin cells on an item at the scene, and that item is collected as possible evidence.

  • It is the DNA in skin cells that is left at a crime scene and may be sampled from a variety of items including gun grips, steering wheels, eating utensils, luggage handles and clothing.
  • Humans shed tens of thousands of skin cells each day, and these cells are transferred to every surface with which human skin comes into contact.
  • Touch DNA is not Low Copy Number DNA (LCN DNA).
  • LCN DNA profiling allows a very small amount of DNA to be analyzed, from as few as 10 to 30 cells.
  • Touch DNA samples are processed exactly in the same way as blood, semen, saliva etc, and can stand up to scrutiny in court much better than LCN DNA.
  • Touch DNA analysis may be able to link the perpetrator to the crime scene, by collecting the skin cells and analyzing them.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Energy Drinks May Put Heart at Risk for Sudden Death

Energy drinks may raise blood pressure and prolong QT interval increasing the risk of sudden cardiac death said Padmashri and Dr B C Roy national Awardee Dr K K Aggarwal President Heart Care Foundation of India and National President Elect IMA.

In a meta-analysis by Sachin A. Shah at University of the Pacific in Stockton,Calif, with a pooled analysis of 93 people who consumed energy drinks, the QT interval on an ECG was significantly prolonged by 10 ms. The threshold level of regulatory concern is around 5 ms.

In another pooled analysis of 132 people by the same group, researchers found a significant increase in systolic blood pressure by 3.5 mmHg that was associated with the consumption of energy drinks.

Doctors are generally concerned if patients experience an additional 30 ms in their QT interval from baseline. QT prolongation is associated with life-threatening arrhythmias.

That energy drinks can prolong the QT and lead to sudden cardiac death, warrants further investigation said Dr Vanita Arora Sr Cardiogist at Max Hospital Delhi.

Half of the energy drinks on the market are consumed by adolescents and young adults added Dr S Arulrhaj Past President Commonwealth Medical Association.

Most energy drinks have caffeine. Drinks such as Monster, Red Bull, Rockstar, Full Throttle, and AMP have three times the amount of caffeine as colas. A 16-oz. can of Monster Energy, for example, contains 160 mg of caffeine, which is almost as much as five cans of soda.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 31697 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

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