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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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

4th November 2012, Sunday

Panel rejects bill on health

Kalyan Ray, New Delhi, Oct 31, 2012, DHNS

Plan to set up regulatory body for medical education hits roadblock

The Centre’s ambitious plan to have an umbrella regulatory body for medical and para-medical education hit a roadblock as the Parliamentary Standing Committee on Health rejected the National Commission for Human Resources for Health Bill, 2011, which provided for a regulatory mechanism.

The panel in its report, submitted to Rajya Sabha Chairman Hamid Ansari on Tuesday, urged the health ministry to withdraw the bill and introduce a fresh one after addressing all opposing points raised by various stakeholders, including state governments.


For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Irritable bowel syndrome with predominant constipation (IBS-C) is characterized by abdominal pain with altered bowel habits. These patients may or may not have slow colonic transit or dyssynergia, and many have visceral hypersensitivity. Abdominal pain in IBS can vary but should NOT be associated with weight loss, rectal bleeding, anemia, and should not be nocturnal or progressive. Patients may note diarrhea, constipation, or both.

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

Weight loss may improve sexual health of obese diabetes

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Heart Care Foundation of India to be in Limca Book of Records

Heart Care Foundation of India created an Indian record by training 1010 students and teachers in one session in Continuous Compression-only CPR called CPR-10. The event was held at Birla Vidya Niketan School on 1st November 2012. Two hundred human dummies were used for the training.

Dr K K Aggarwal
    National News

19th MTNL Perfect Health Mela 2012 From 1st November to 11th November 2012

click for Programme

Today’s Program

Panel Discussion on Chronic Constipation
Constitution Club of India, Rafi Marg
Time - 9 am to 12 Noon

Chaat Party
23, Bhai Veer Singh Marg, Gole Market Special

Supplement Navbharat Times
on Cardiac First Aid
Date: 4th November, Sunday 2012

My Profession My Concern

Quality control

Conduction of an Assisted Vaginal Delivery (forceps & vacuum extraction):

  • Conduction of an assisted vaginal delivery was not possible at the community level due to obvious reasons. Hence it was universally felt that:
  • Assisted vaginal deliveries (i.e. the use of obstetric forceps or vacuum extraction) should be carried out by the Medical Officer only.
  • The ANMs and the staff nurse need to be trained in the use of a partograph, for diagnostic purpose only. This will help her in taking a decision for referral in a case of prolonged labour.

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

    Valvular Heart Disease Update

Concurrent tricuspid valve surgery with chronic MR surgery

Concurrent tricuspid annuloplasty in patients with mitral valve prolapse who have significant tricuspid annular dilatation (annular diameter from the anteroseptal to anteroposterior commissure =70 mm) or pulmonary hypertension even when there is only mild to moderate TR

(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)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Simple eye tests accurately identify schizophrenia

Using a series of simple eye tests to identify abnormal eye movements may help clinicians to distinguish patients with schizophrenia from those without, new research suggests. (Source: Medscape)

For comments and archives

Group issues new antiplatelet guideline

With a host of new antiplatelet drugs on the market, the Society of Thoracic Surgeons (STS) has updated its clinical practice guideline on the drugs' use during heart surgery. Patients at high risk of bleeding should stop taking P2Y12 inhibitors such as clopidogrel (Plavix) and prasugrel (Effient) for a few days before cardiovascular operations (class I, level of evidence B), according to the statement by Victor A. Ferraris, MD, PhD, from the University of Kentucky in Lexington, and colleagues. The new guidelines also indicate that aspirin discontinuation before purely elective operations in patients without acute coronary syndromes is reasonable to decrease the risk of bleeding. Prasugrel, a more potent antiplatelet agent than clopidogrel, increases the risk of bleeding following coronary artery bypass grafting (OR 4.7), which must be balanced with its benefits, the STS task force noted in the November 2012 issue of the Annals of Thoracic Surgery. (Source: Medpage Today)

For comments and archives

Support vest cuts sternal wound infections by 50% after cardiac surgery

A vest used to stabilize the chest following cardiac surgery has slashed the rate of deep sternal wound infections by 50% in a large, prospective, multicenter, randomized trial. Dr Michael Gorlitzer (Hospital Hietzing, Vienna, Austria) reported the results during a late-breaking clinical trial session here today at the European Association for Cardio-Thoracic Surgery (EACTS) 2012 Annual Meeting. (Source: Medscape)

For comments and archives

Autoimmune disease tied to preeclampsia

Among women with autoimmune diseases, the use of disease-modifying anti-rheumatic drugs (DMARDs) during pregnancy was associated with a slightly increased risk of preeclampsia, which may have reflected disease activity, researchers reported. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: 116 school principals of South MCD trained in cardiac first-aid In a function held at MCD School Srinivaspuri,... http://fb.me/1WkjuHHiE

@DeepakChopra: Stop playing small. You are divinity in motion.

    Spiritual Update

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

Prayer for Inner Happiness

Stress is defined as the physical and mental reaction to the interpretation of a known situation. In absence of a known situation there cannot be a stress. One cannot be stressful for a person who has just died in New York in an accident unless he or she is a known person.

There has to be a right, conscious based interpretation of the situation as the same situation can bring happiness to one and stress to the other.

For comments and archives

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

Assisted hatching is a safe process or not?

In Assisted hatching the embryo or some of the cells (blastomeres) in the embryo can be damaged by this procedure. There have also been a few cases of an increase in the incidence of either identical twins or conjoined (Siamese) twins after assisted hatching. These pregnancies are considered high risk.

For comments and archives

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

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

Primary reason for transfusing blood

Blood Grouping systems:

    • ABO
    • Rh
    • Other Groups

For comments and archives

    An Inspirational Story

You Are Unique

You may not think that the world needs you, but it does. For you are unique, like no one that has ever been before or will come after.

No one can speak with your voice, say your piece, smile your smile, or shine your light. No one can take your place, for it is yours alone to fill.

If you are not there to shine your light, who knows how many travelers will lose their way as they try to pass by your empty place in the darkness?

For comments and archives

    Cardiology eMedinewS

Pulmonary Hypertension Treated Effectively With Riociguat Read More

Novel Drug Helps Statins Cut Cholesterol Read More

    Pediatric eMedinewS

Spices Lower Lifestyle Related Disesase Read More

Head Lice Lotion Safe, Effective Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with pneumonia not responding to antibiotics came to the hospital.
Dr Bad: Change the antibiotic.
Dr Good: You need hospitalization.
Lesson: Any patient not responding appropriately to oral antibiotic therapy requires in–patient management.

For comments and archives

Make Sure

Situation: A hypertensive with obstructive sleep apnea (OSA) was not responding to CPAP?
Reaction: Oh my God! Why was an anti hypertensive drug not started?
Lesson: Make sure that all hypertensives with OSA are given anti HT drugs in addition to CPAP. In a randomized crossover trial of 23 patients with OSA and systemic hypertension, an anti–hypertensive medication (valsartan 160 mg per day) lowered the mean 24–hour blood pressure significantly more than CPAP (Continuous positive airway pressure therapy)therapy alone. (Am J Respir Crit Care Med 2010;182:954).

For comments and archives

    Legal Question of the Day (Dr MC Gupta)

Need, purpose, efficacy and changes needed in the PC&PNDT Act

There is lot of criticism about the PC&PNDT Act. Some critiques want it to be scrapped on the ground that it has resulted in harassment of doctors and has led to corruption and has been ineffective in improving the sex ratio. Others agree with the grounds of criticism but want the Act to be amended rather than scrapped. Let us examine the issue.

What are your own views regarding the PNDT Act in the context of low sex ratio?


  • The PNDT Act is not implementable. Now restrictions are being placed upon portable ultrasound machines. Ultrasound is an important diagnostic procedure of utility much wider than detecting the sex of the unborn. Restricting this technique because of possible misuse is like banning the cultivation and use of mustard because of the possibility of contamination leading to epidemic dropsy.
  • Newer techniques for sex selection cannot be monitored by any government mechanism. These include a hand-held ultrasound device including its cheap Chinese versions. These also include a recently announced technique to detect the sex of the fetus at 4 weeks gestational age by a simple blood test of the mother’s blood which measures the levels of two enzymes.

  • Low sex ratio does not have its root cause in the ultrasound machine. It was low even before ultrasound became common. All that the ultrasound has done is to hasten a pre-existing trend. Banning ultrasound cannot banish the pre-existing trend.
  • Even without ultrasound, several techniques have been used in the society for centuries to eliminate the girl child. Some of these are as follows:
    • Physically smothering the baby girl at birth;
    • Letting her choke on milk/water poured in her mouth
    • Burying her alive in the ground or throwing her in a pond etc.
    • Chronic deprivation of the girl child from food, nutrition, medicines etc.
  • The root causes of female killing are: poverty; lack of security as regards crimes against women; a girl is seen as an economic burden, especially when viewed in the context of dowry. All these basically converge into a single attribute—Non-empowerment of women/low socio-economic status of women.
  • If sex ratio has to be improved, the root causes need to be addressed, rather than focus all attention upon restricting the use of ultrasound. Measures to raise the social status and empowerment of women on a war footing can yield effective results within one generation.
  • Some of the legal and administrative measures that can be taken to improve sex ratio are as follows:
    • The goal of 100% female literacy (defining literacy as education up to primary school) should be achieved at whatever cost by whatever means. It must be remembered that education is the best means of empowerment. If necessary, specific central or state laws should be made for this purpose. The performance of states and districts as regards achievement of this time bound goal should be strictly monitored and bottlenecks removed; incentives given; and, disincentives/punishment imposed.
    • The bill for one third reservation of women in legislatures/parliament should be passed without delay. This will be a step towards empowerment of women.
    • The Law Commission in its Report dated 2008 recommended as follows-- “a Marriage and Divorce Registration Act” (hereinafter referred to as the “proposed law”) should be enacted by Parliament, to be made applicable in the whole of India and to all citizens irrespective of their religion and personal law and without any exceptions or exemptions.” The above recommendation should be implemented without delay. Such an Act will go a long way in empowering women and reducing crimes against them.
    • India’s National Population Policy, 2000, envisages compulsory registration of pregnancies. This suggestion should be implemented by appropriate legislation or executive action. This will ensure monitoring of pregnancies and will help in identifying and avoiding attempts at selective female foeticide.
    • The income tax law should be amended to provide the following:
      • Further increase substantially the relief in income tax in case of women;
      • A legal provision to recognise house- keeping as a legitimate activity for the purpose of income tax, providing thereby that one fourth of the husband’s income (with a certain maximum limit) would be deemed to have been paid to the wife towards the service of house-keeping. This amount paid should be treated as the wife’s independent non-taxable income. (Suitable provisions would need to be included where the main earning spouse is the wife and house-keeping is done mainly by the husband).
    • Investigation and trial related to crime against women should be fast paced in a time bound manner by taking necessary measures.
    • The existing PC&PNDT Act should be scrapped or radically altered.
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    Quote of the Day (Dr GM Singh)

Blessed is the season which engages the whole world in a conspiracy of love. Hamilton Wright Mabi.

    Mind Teaser

Read this…………………

Jose, who is admitted to the hospital for chest pain, asks the nurse, “Is it still possible for me to have another heart attack if I watch my diet religiously and avoid stress?” The most appropriate initial response would be for the nurse to:

A. Suggest he discuss his feelings of vulnerability with his physician.
B. Tell him that he certainly needs to be especially careful about his diet and lifestyle.
C. Avoid giving him direct information and help him explore his feelings
D. Recognize that he is frightened and suggest he talk with the psychiatrist or counselor.

Yesterday’s Mind Teaser: Twenty four hours after admission for an acute MI, Jose’s temperature is noted at 39.3 C. The nurse monitors him for other adaptations related to the pyrexia, including:

A. Shortness of breath
B. Chest pain
C. Elevated blood pressure
D. Increased pulse rate

Answer for Yesterday’s Mind Teaser: D. Increased pulse rate

Correct answers received from: Dr PC Das, Dr KV Sarma, Dr Jella, Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Arvind Khanijo, Dr K Raju, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr Kanta Jain, Dr B K Agarwal, Muthumperumal Thirumalpillai.
Answer for 2nd November Mind Teaser: The numbers are in alphabetical order.
Correct answers received from: Dr Thakor Hitendrsinh G, Dr P C Das.

Send your answer to ijcp12@gmail.com

   Laugh a While (Dr GM Singh)

Physical Problems

A gentleman was having some physical problems and his doctor told him that he had to drink warm water with Epsom Salts one hour before breakfast. At the end of a week he returned and the doctor asked if he was feeling better.

The man said that he actually felt worse. "Did you drink warm salt water an hour before breakfast each day?" the Doc asked.

"No," replied the man somberly, letting out a sigh. "I could only do about 15 minutes!"

    Medicolegal Update

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

Do not misrepresent the document/medical literatures in the court of law

One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point a doctor wants to make in a court room. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time consuming. The document must potentially be available to any debater researching the topic or lawyer/interested party of cross examination side.

  • The portion of a document read as evidence cannot be taken out of context. When a document is cut in a manner which lends the quoted passage a meaning other than what would be derived from a more complete reading, you are misrepresenting the document. This does not mean, however, that you are responsible for drawing the same conclusions from information as the author of the document.
  • Drawing a contrary conclusion from passages accurately interpreted does not constitute misrepresentation. The fact that the author of the document reached a different conclusion from the information argues – perhaps persuasively – against your conclusion. However, you have not misused the evidence.
  • Read the used evidence literature verbatim in the court of law. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. A document obviously will seem to support your point if you are allowed to read into the record only what you think it says.
  • The advent of the Internet has created a new form of publication – electronic documents like this emedinews. Electronic documents are accepted as published if they are accessible by the general public. Thus, electronic files to which other debaters would be denied access are not published. However, files and documents which other debaters may access, even if they have no subscribe to a commercial service to do so, satisfy the publication rule.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

In paralysis, act fast

In an audience based interaction on paralysis, Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, Dr. Vinit Suri, Senior Neurologist, Apollo Hospital and Dr. Vibha Sharma, Ayurvedic Consultant said that brain attach should be tackled like a heart attack. As time is brain, a patient with suspected paralysis/stroke or brain attack should be shifted to hospital at the earliest and given a clot dissolving therapy if the CT scan is negative for brain hemorrhage. Prevention for paralysis is the same as prevention for heart attack.

All patients with paralysis should undergo testing for underlying heart disease and all patients with heart diseases should undergo testing to detect blockages in the neck artery which can cause future paralysis.

The programme was organized as part of 19th MTNL Perfect Health Mela celebrations which will open to general public on 7th November, 2012 at Constitution Club of India and will be a mix of exhibitions, competitions, workshops, seminars, entertainment incorporating all pathies under one roof. The entry to the mela will be free. The programme will have a telecast in DD India.


  1. One should rule out brain hemorrhage as soon as possible
  2. Obtain emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke
  3. Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL start insulin
  4. Maintain normothermia for at least the first several days after an acute stroke
  5. For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre-eclampsia/eclampsia)
  6. For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic blood pressure is =185 mmHg and diastolic blood pressure is =110 mmHg
  7. Antithrombotic therapy should be initiated within 48 hours of stroke onset.
  8. For patients receiving statin therapy prior to stroke onset it should be continued

    Breast Cancer is on the rise

    In another discussion organized by the Heart Care Foundation of India, Dr. KK Aggarwal, President of the Foundation, Dr. P.K. Julka, Senior Cancer Specialist, AIIMS and Dr. Anurag Srivastava, Breast Cancer Surgeon, in a joint statement said that breast cancer is on the rise in the country. The doctors said that breast cancer, prostate cancer and heart diseases are all linked to obesity, eating refined carbohydrates, smoking and access of alcohol.

    They said that eating vegetarian diet with large amount of fruits and vegetables, exercising regularly and no smoking and drinking in moderation can reduce the chances of breast cancer.
  • Globally, breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females.
  • Risk factors have been associated with female breast cancer are Age and gender; Race and ethnicity; Benign breast disease; Personal history of breast cancer; Lifestyle and dietary factors; Reproductive and hormonal factors; Family history and genetic factors; Exposure to ionizing radiation; Environmental factors and Smoking
  • Men are more than one hundred times less likely to get breast cancer than women.
  • Women can take to decrease their risk of breast cancer. These include lifestyle changes: minimize use of postmenopausal hormones, childbearing at a younger age, breastfeeding for at least six months, avoidance of adult weight gain, limiting alcohol consumption, avoidance of smoking, regular physical activity), chemoprevention and early detection through screening mammography.
  • Breast cancer is the most common female cancer
  • It is second most common cause of cancer death in women
  • It is main cause of death in women ages 40 to 59.
  • Important risk factors for breast cancer are age, gender, hormonal factors, and family history.
  • The diagnostic evaluation of a patient with suspected breast cancer includes diagnostic breast imaging and breast biopsy.
  • All primary breast cancers should be evaluated for expression of hormone receptors (estrogen [ER] and progesterone (PR) receptors) and human epidermal growth factor receptor 2 (HER2) expression.
  • The treatment of early breast cancer includes locoregional treatment with surgery, radiation therapy, or both, and the treatment of systemic disease with one or a combination of chemotherapy, endocrine therapy, or biologic therapy.
  • Many women have the option of preserving a cosmetically acceptable breast with breast conserving therapy (BCT) without sacrificing survival.
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  1. Thank you sir, your blog is a source of spiritual upliftment, may you go a long way with it. Dr. Sanjana Goswami.
    Forthcoming Events
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