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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 …

4th September 2011, Sunday

Loopholes in Supreme Court Judgment of hospital providing free services

  1. The definition of a person “from economically weaker section of the society” is not clear. It is definitely not BPL. Anybody whose income is less than minimal wages will qualify to be included in the economically weaker section of the society. The government will have to come out with clear guidelines as to who all would be included into this category. It seems the government has appointed nodal officers who will classify these people. If that happens no emergency admissions may be taken directly by the hospitals as the cases may need to be routed through the nodal officer who obviously will not be available for 24 hours and on holidays. .
  2. Medical establishments will prefer medical cases over surgical cases to fill the beds. Will the government consider fixing the beds for different specialties as there are no directions from Supreme Court? Unless the government acts, this will never happen..
  3. Will there be discharge guidelines? Normally, any private hospital wants the patients to be discharged as early as possible so that the next patient can be admitted. This is based on the findings that maximum earning to the hospital is in the first 2 to 3 days of admission. After this period, the earning is only from room rent and doctor’s fee. Hospitals may not discharge these free bed patients for days together to prevent admission of new surgical patients
  4. For the same reason, it is likely that a free ward patient may not get a prime time in the OT list. After getting admitted, he or she may have to wait for days together to get the turn for surgery.  .
  5. Same thing could take place in getting dates for investigations.
  6. A patient for bypass who is normally discharged in 4 to 5 days may end up being hospitalized for up to 3 weeks to get the same surgery done.
  7. As there are no clear cut guidelines, it is possible that these free bed patients will be treated with generic drugs and with only minimal basic investigations. Most of the treatment will be based on clinical judgments.
  8. The guideline does not specify if the patient has to be put on stent or pacemaker. Will this be the indigenous cheapest one available in the market or the standard imported one? It is likely that these patients will get bare metal indigenously made stents and not the drug eluting standard stents. Same thing could also apply to other appliances and devices.
  9. Normal practice is to look for indications for doing the surgery. For free bed patients, efforts will be made to find indications for not doing surgery. For example, there is a current recommendation that a patient should get a ICD (pace maker with electrical shock device), if the pumping fraction of the heart is less than 30%. For a private patient, a 31% ejection fraction would be written as 29% and for poor patients, a 29% ejection fraction will be labeled as 31%.
  10. Many of the rooms may get blocked with patients requiring long term care which are normally not encouraged to be admitted in private wards. The internal auditors of most major hospitals everyday review as to why a particular patient is staying in the hospital after five days of admission. The unwritten policy is to ask the consultants to discharge a patient if the stay is for more than 5 days. Will the same guideline apply for free beds?

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

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

Loopholes in Supreme Court Judgment of hospital providing free services

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Nurses from various Nursing College took active participate in Poster making competiton in Divya Jyoti – Nurses Festival 29th October 2010.

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


India records highest number of new born deaths: UN

More new born babies die in India annually than in any other country, even though the number of neonatal deaths around the world has seen a slow decline, a new study by the World Health Organisation (WHO) has said. New born deaths decreased from 4.6 million in 1990 to 3.3 million in 2009, and fell slightly faster in the years since 2000, according to the study led by researchers from WHO, Save the Children and the London School of Hygiene and Tropical Medicine. The study, which covers a 20–year–period and all the 193 WHO member states, found that new born deaths – characterised as deaths in the first four weeks of life (neonatal period) – account for 41% of all child deaths before the age of five. Almost 99% of the newborn deaths occur in the developing world, with more than half taking place in the five large countries of India, Nigeria, Pakistan, China and Congo. "India alone has more than 900,000 newborn deaths per year, nearly 28% of the global total," WHO said, adding that India had the largest number of neonatal deaths throughout the study. (Source: TOI, Sep 1, 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 Update

  • The antipsychotic drug asenapine maleate can cause life–threatening allergic reactions, even at the first dose.
  • The osteoporosis drug zoledronic acid should not be used in patients with significant renal impairment. One should screen patients for kidney dysfunction before starting this drug.

For comments and archives

Colonoscopy pioneer William Wolff dead at 94

One of the pioneers of modern colonoscopy, William Wolff, MD, has died at the age of 94. Wolff and Hiromi Shinya, MD, working at New York City’s Beth Israel Medical Center in the late 1960s, were among the first to use a flexible fiberoptic endoscope to probe the full length of the colon. At that time, Wolff and Shinya wrote, they had extensive experience – more than 1,000 procedures –– using endoscopes to examine the stomach and esophagus. It was a "logical extension," they wrote, to use a similar – but specially–built – instrument to probe from the other end of the gastrointestinal tract. Between June 1969 and June 1972, they reported in the New England Journal of Medicine (N Engl J Med 1973;288:329–332), they had performed more than 1,600 diagnostic procedures using the colonoscope "without morbidity or mortality. "Their most significant advance was a device designed by Shinya – a wire loop snare–cautery that enabled physicians to remove a polyp immediately, making a second procedure unnecessary. (Source: Medpage Today)

For comments and archives

New Swine Flu sickens two kids

Novel H3N2 swine flu viruses have sickened two children, the CDC is reporting. The children –– a boy from Indiana and a girl from Pennsylvania, both younger than 5 – were treated in July and August, respectively, and have since recovered, the agency said in a special issue of Morbidity and Mortality Weekly Report. The viruses are similar but not identical to each other, the CDC says, and differ from eight other H3N2 infections identified in people over the past two years because they both contain the so–called matrix gene from the pandemic H1N1 influenza strain.

The viruses are called "reassortants" –– they contain genes of the H3N2 swine influenza that has been circulating in North American pigs since 1998 as well as the gene from the pandemic virus –– but such re–assortments have been reported previously in swine. The infected boy had no direct contact with pigs, but his symptoms –– including fever, cough, shortness of breath, diarrhea, and sore throat –– began two days after he was cared for by someone who’d had direct contact with asymptomatic animals in the preceding weeks. The girl, on the other hand, had been to an agricultural fair where she had direct exposure to swine. Four days later, she was taken to the hospital with fever, nonproductive cough, and lethargy. There is no apparent link between the two children, the CDC said. Both children had been vaccinated in September 2010 against the pandemic H1N1 flu, the agency reported. (Source: Medpage Today)

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    Fitness Update

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

Losing weight, keeping it off might require distinct skill sets

A new study indicates that the practices that help people to lose weight and the practices that help them keep it off do not overlap much. whether two distinct sets of behaviors and thought patterns were involved in weight loss and its maintenance were investigated in a study. Practices associated with successful weight loss only were:

  • Participate in a weight–loss program
  • Look for information about weight loss, nutrition or exercise
  • Eat healthy snacks
  • Limit the amount of sugar you eat or drink
  • Plan what you’ll eat ahead of time
  • Avoid skipping a meal, including breakfast
  • Do different kinds of exercise
  • Do exercise that you enjoy
  • Think about how much better you feel when you are thinner

Practices significantly associated with successful maintenance only were:

  • Eat plenty of low–fat sources of protein
  • Follow a consistent exercise routine
  • Reward yourself for sticking to your diet or exercise plan
  • Remind yourself why you need to control your weight

If the two stages do demand different practices, then weight loss programs might need to guide people about key strategies for each phase explicitly, said Sciamanna, a professor of medicine and public health sciences at the Penn State College of Medicine. The study appears online and in the August issue of the American Journal of Preventive Medicine. Sciamanna’s group surveyed a random sample of 1,165 adults by telephone. Some had been successful at losing weight; some had also maintained a weight loss. They asked them about 36 things they might do and think about to lose weight and keep it off. The researchers defined long–term success as losing at least 30 pounds and keeping if off for a year. Fourteen practices were associated with either successful loss or successful weight loss maintenance, but not both. The overlap between practices associated with weight loss and those associated with weight loss maintenance was 61 percent, not much higher than that expected by chance.

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    Twitter of the Day

@DrKKAggarwal: #AJENT Nocturnal ACS linked to belly fat, disordered sleep Nighttime acute coronary syndrome (ACS) occurred…fb.me/EiUkNqas

@DeepakChopra: #CosmicConsciousness Enlightenment is not knowledge that is learned but a state one must enter & become

    Dr KK Answers

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

What are the lab abnormalities in drug fever?

  1. The white blood cell count can be elevated with accompanying eosinophilia.
  2. The ESR is usually increased.
  3. Liver and renal dysfunction
  4. Urine can be checked for eosinophils especially in interstitial nephritis caused by beta–lactam antibiotics.

For comments and archives

    Spiritual Update

Purusha means human being and artha means object or objective. Purusharthas means objectives of man.

According to Vedanta a person should strive to achieve four main objectives (Purusharthas) in his life. They are:

  1. Dharma (righteousness),
  2. Artha (material wealth),
  3. Kama (desire) and
  4. Moksha (salvation).

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Be Content about Your Life

Wonder if any of you ever had the feeling that life is bad, real bad,…and you wish you were in another situation. Do you find that life seems to make things difficult for you, work sucks, life sucks, everything seems to go wrong……

It was not until yesterday that I totally changed my views about life; after a conversation with one of my friends.

He told me despite taking two jobs, and bringing back barely above 1K per month, he is happy as he is. I wonder how he can be as happy as he is now, considering that he has to skimp his life with the low pay to support a pair of old-age parents, in–laws, wife, 2 daughters and the many bills of a household.

He explained that it was through one incident that he saw in India……

That happened a few years ago when he was really feeling low and was touring India after a major setback. He said that right in front of his very eyes, he saw an Indian mother chopped off her child’s right hand with a chopper. The helplessness in the mother’s eyes, the scream of the pain from the innocent 4 years old child haunted him until today. You may ask why did the mother do so, has the child been naughty, was the child’s hand infected??

No, it was done for two simple words — to beg. The desperate mother deliberately caused the child to be handicapped so that the child can go out to the streets to beg. I cannot accept how this could happen, but it really did, just in another part of the world which I don’t see.

Taken aback by the scene, he dropped a small piece of bread he was eating half–way. And almost instantly, flock of 5 or 6 children swamp towards this small piece of bread which was then covered with sand, robbing of bits from one another. The natural reaction of hunger. Stricken by the happenings, he instructed his guide to drive him to the nearest bakery. He arrived at two bakeries and bought every single loaf of bread he found in the bakeries.

The owner is dumbfounded, but willing sold everything. He spent less than $100 to obtain about 400 loaves of bread (this is less than $0.25/per loaf) and spend another $100 to get daily necessities. Off he went in the truck full of bread into the streets. As he distributed the bread and necessities to the children (mostly handicapped) and a few adults, he received cheers and bows from these unfortunate. For the first time in life he wonders how people can give up their dignity for a loaf of bread which cost less than $0.25. He began to ask himself how fortunate he is as a Singaporean. How fortunate he to be able to have a complete body, have a job, have a family, have the chance to complain what food is nice what isn’t, have the chance to be clothed, have the many things that these people in front of him are deprived of……

Now I begin to think and feel it, too. Was my life really that bad?

Perhaps…no,… it should not be bad at all…

What about you? Maybe the next time you think you are, think about the child who lost one hand to beg on the streets.

For comments and archives

    Gastro Update

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

When should chronic liver disease be suspected in children ?

  • Chronic liver disease includes a wide spectrum of diseases characterized by ongoing inflammation of liver tissue which can progress to cirrhosis or end stage liver disease.
  • It refers to long–standing disease, usually >3–6 months duration leading to various manifestations and complications of CLD.

For comments and archives

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


It is not a routine test. It is ordered primarily to help differentiate between different types of anemia and to determine whether the amount of erythropoietin being produced is appropriate for the level of anemia present. It is usually ordered following abnormal findings on a complete blood count (CBC), a group of tests that includes a RBC count and evaluation, a hemoglobin, and a hematocrit.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient developed tetany after he was given metoclopramide.
Dr Good: Stop metoclopramide. Give inj promethazine.
Dr Bad: Give calcium.
Lesson: Metoclopramide can cause extrapyramidal symptoms.

For comments and archives

Make Sure

Situation: A patient with angina and abnormal endothelial functions was put on atenolol.
Reaction: Oh my God! Why you did not consider nebivolol?
Lesson: Make sure that nebivolol is used as the beta blocker of choice in patients with proven endothelial dysfunction (Kardiologiia 2004;44(2):15–18).

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  Quote of the Day

(Dr GM Singh)

Confidence comes naturally with success But, success comes only to those who are confident. So, begin your day with great confidence.


Between a Rock and a Hard Place: Stuck between two very bad options.

    G P Pearls

(Dr Pawan Gupta)

Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD (Thorax 2010 Mar;65(3):215–20).

    Medicolegal Update

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

What is the difference between antemortem and postmortem bruises?

A bruise is also called a contusion.

  • Some people bruise easily, whereas others may have tougher skin tissue. Apply a cold compress to the bruise for at least 10 minutes to reduce swelling or the amount of bruising after an injury.
  • In some cases of brought dead or dead in arrival, the doctor attending the case in emergency may get confused or may not be able to differentiate between antemortem bruise and postmortem artifacts and the postmortem bruise is entered in MLC as injury. I have seen many such cases in AIIMS while conducting an autopsy.
  • But, it is possible to differentiate on close examination because in antemortem bruises there is swelling and damage to epithelium, coagulation and infiltration of the tissues blood and color changes. These signs are always remain absent in postmortem bruises.
  • It is seen that contusions and abrasions produced immediately after death show a very low degree of changes.
  • Appreciable bruising does not occur after 2–3 minutes of death due to arrest of heart and blood circulation, but by using great violence small bruises can be produced up to 3 hours after death where the tissue can be forcibly compressed against the bone or if the body is dropped on the ground from a height or from transport trolleys or running vehicle.
  • Some of the evidences of bleeding are seen without history of trauma due to tearing of small veins in the skin when the body is lifted from the scene of death and transportation handling and the same is called postmortem artifact.

For comments and archives

    Mind Teaser

Read this…………………

Which one of the following anesthetic agents causes a rise in the Intracranial pressure:

1. Sevoflurane
2. Thiopentone sodium
3. Lignocaine
4. Propofol

Yesterday’s Mind Teaser: The most common pathogens responsible for nosocomial pneumonias in the ICU are:

1. Gram–positive organisms
2. Gram–negative organisms
3. Mycoplasma
4. Virus infections

Answer for Yesterday’s Mind Teaser: 2. Gram negative organisms

Correct answers received from: Dr YJ Vasavada, Dr ValLuri Ramarao, Dr Pramod M Kulkarni,
Dr K Raju, Dr Chandresh Jardosh, Dr US Murty, Dr Muthumperumal Thirumalpillai, Dr Neelam Nath,
Dr Jainendra Upadhyay, Dr Anil Bairaria, Dr Dilip Kumar Jha, Dr Priyanka Sharma, Dr Dinesh Yadav,
Dr Dilip Kumar Jha, Dr Shirish Singhal.

Answer for 1st September Mind Teaser: 1. An asymptomatic abdominal mass
Correct answers received from: Dr S Upadhyaya, Dr Anil Kumar Jain, Dr Valluri Ramarao, Dr Avtar Krishan, Dr Gunjesh kumar, Dr K Raju.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

Smart answers

If it took eight men ten hours to build a wall, how long would it take four men to build it? No time at all it is already built. (UPSC 23rd Rank Opted for IFS)

    Drug Update

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

Drug Name
DCI Approval Date
Hydroquinone USP 2% w/w + Tretinoin USP 0.025% w/w + Allantoin USP 1%w/w Gel
For treatment of hyperpigmentary disorders
    Public Forum

(Press Release for use by the newspapers)

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Air pollution is linked to heart disease

Air pollution is linked to heart disease said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Here is the evidence:

  1. Women’s Health Initiative Observational study database of more than 65,000 post menopausal women without prior heart disease has shown that each 10 μg/m3 increase in pollution concentration increases the risk of any cardiovascular event by 1.24, death from heart disease by 1.76 ad paralysis by 1.35.
  2. Mortality data from nearly 450,000 patients in the American Cancer Society Cancer Prevention Study II database has shown that fine particulate matter =2.5 micrometers in diameter (PM2.5) is associated with the risk of death from cardiovascular causes (relative risk 1.2).
  3. In Dublin, Ireland ban on coal sales led to a 70 percent reduction in black smoke concentrations and adjusted cardiovascular deaths fell by 10.3 percent in the six years after the ban.
  4. Short–term exposure to air pollutants (both ozone and fine particulate matter) is associated with acute coronary ischemic events.
  5. A short–term increase in fine ambient particulate matter has been shown to precipitate acute ischemic coronary events.
  6. Carbon particulates in the air from the burning of fossil fuels, wood, and other materials scatter and absorb UVB rays. Ozone absorbs UVB radiation, so holes in the ozone layer can lower vitamin D levels and future heart disease.

Possible mechanisms by which fine particulate air pollution may increase the risk of heart disease are:

  • An increase in mean resting arterial blood pressure through an increase in sympathetic tone and/or the modulation of basal systemic vascular tone
  • An increase in the likelihood of intravascular thrombosis through transient increases in plasma viscosity and impaired endothelial dysfunction
  • Initiation and promotion of atherosclerosis

For comments and archives

    Readers Responses
  1. I sincerely appreciate your honest opinion about feverfew and butterbur in the treatment of migraine. We all should come forward to stop this big drama of alternative medicine. I am not against any pathy but drugs should be used after authentic trials because body is too precious for experimentation. Mr Vivek Kumar, Varanasi
    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


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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