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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 …

5th January 2013, Saturday

American College of Cardiology Names Top Cardiovascular Stories of 2012

  • Electronic applications moved into the doctor’s office. iPhone apps were introduced to generate electrocardiograms (ECGs), help diagnose atrial fibrillation, or help patients quit smoking while the ACC’s CardioSmart Explorer app was introduced to provide animated 3D heart images to help cardiologists explain conditions to their patients.
  • The Choosing Wisely campaign got national attention. The campaign was meant to help open the discussion between patients and providers about the costs, risks and benefits of certain procedures.
  • Bariatric surgery identified as tool for controlling diabetes in obese patients with type 2 diabetes.
  • The FDA expanded approved uses for transcatheter aortic valve replacement for high-risk patients. Previously, the FDA had approved the treatment for only inoperable patients.
  • Warfarin alternative rivaroxaban was approved to treat pulmonary embolism and deep vein thrombosis
  • CABG identified as better than PCI stents for treatment of patients with diabetes and multi-vessel coronary artery disease.
  • New cholesterol lowering drug showed potential. PCSK9 inhibitors demonstrated success in significantly lowering LDL cholesterol.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

    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.

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Proton–pump inhibitors to carry warning about C

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

A seminar was organized by Indian Medical Association (IMA) on 4th January 2013 at IMA Hall.

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

No screening tests for overseas Indian doctors to practise in their homeland

KOCHI: The Centre would permit overseas Indian doctors to practise in the country without undergoing screening tests, Union Health Secretary P K Pradhan said on Wednesday. In what is viewed as the first major impact of the ongoing Global Healthcare Summit, Pradhan said the Centre was ready with the bill to amend the Medical Council of India ( MCI) Act and allow overseas Indians to practise in their homeland as demanded by the expatriate professionals for long. "We expect to bring the bill during the Budget Session of Parliament," he said, addressing the CEO Forum held as part of the three-day healthcare summit which began yesterday. The high-profile Forum, attended by top brass from the industry and senior officials from the Centre and the state, also decided to workout modalities to broaden the PPP by tapping into the strengths of both the sides. It was the first time such a face-to-face meeting between the regulatory authorities and the industry captains in the history of the global summit. Soliciting ideas and partnerships from the private sector, Pradhan said the government was planning to improve the secondary care by upgrading the district hospitals. "There is a huge scope for partnership with the private sector in the areas like diagnostic services and labs. We will encourage district hospitals to run medical college campuses to augment the capacity in PG education and private players can help in this area," he said. Welcoming enterprising ideas from private practitioners, Director General of Health Services Dr Jagdish Prasad urged the private sector hospitals to reserve 10 per cent of services free of cost to the poor people under the corporate responsibility and in a bid to make the healthcare accessible. Chairing the session, Advisor to the Prime Minister T K A Nair wanted both the Government and the private sector players to prepare a roadmap to ensure make accessible affordable drugs and healthcare to the people. He offered to work as link and further frame a mechanism to take the initiative further. (Source: The Economic Times, 2 Jan, 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

    Valvular Heart Disease Update

Errors in diagnosing MR severity

  • Severe chronic MR does not exist without left atrial or left ventricular enlargement.
  • If LVEDD (Left ventricular end–diastolic diameter) is < 60 (35 mm/m2), then revise the diagnosis of severe chronic MR.
  • Left atrial enlargement defines the severity and duration of chronic MR.

(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)

Flu vaccine at quadruple dose needed for those with HIV

A quadruple-dose vaccine may be the answer for protecting patients with HIV from seasonal influenza, according to results from a study published in the January 2013 issue of the Annals of Internal Medicine. (Source: Medscape)

For comments and archives

Peanut allergy: Sublingual immunotherapy shows promise

Results from a new randomized controlled trial show that sublingual immunotherapy (SLIT) for peanut allergy induces a moderate level of desensitization with minimal adverse effects compared with placebo. Results of the study were published in the January 2013 issue of the Journal of Allergy and Clinical Immunology. (Source: Medscape)

For comments and archives

Fructose effects in brain may contribute to overeating

Consuming fructose appears to cause changes in the brain that may lead to overeating, a new study suggests. "Increases in fructose consumption have paralleled the increasing prevalence of obesity, and high-fructose diets are thought to promote weight gain and insulin resistance," lead author Kathleen A. Page, MD, and colleagues from Yale University in New Haven, Connecticut, write. (Source: Medscape)

For comments and archives

Lesser degrees of excess weight do not increase mortality

Severe obesity is associated with an increased risk for death from all causes, but lesser amounts of excess weight either do not increase the risk or may be protective, according to the results of a systematic review and meta-analysis. The findings were published in the January 2, 2013, issue of JAMA by Katherine M. Flegal, PhD, from the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, and colleagues. (Source: Medscape)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Examination of a rape victim 1. First and foremost make the woman/girl/child comfortable - she has been through (cont)http://tl.gd/kj86ph

@DeepakChopra: Infinity is reality. Limitations are conceptual RT @MyOpenMind101: If we are connected are there limits to this connectedness?

    Spiritual Update

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

Do not believe in claims

Most of the claims reported in television and newspapers may not be based on the facts. Whenever somebody comes and tells me that he has cure for HIV-AIDS, I only ask him a question, “Did you get Noble prize so far?” or “Have you patented your claim?” If the answer is no, I do not believe in that claim.

For comments and archives

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

Is laparoscopy a risky procedure to retrieve eggs?

Laparoscopy carries the same risks of any surgery that requires anesthesia. Removing eggs through an aspirating needle entails a slight risk of bleeding, infection and damage to the bowel, bladder, or a blood vessel. This is true whether the physician uses laparoscope or ultrasound to guide the needle. Less than one patient in 1,000 will require major surgery to repair damage from complications of the egg retrieval procedure.

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

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

Mechanical infusion devices

Mechanical pumps that deliver infusions at a controlled rate are useful especially for very slow rate of transfusion used for pediatric, neonatal, and selected adult patients. Some pumps use a mechanical screw drive to advance that plunger of a syringe filled with blood; others use roller pumps or other forms of pressure applied to the infusion tubing. Although some can be used with standard blood administration sets, many require special plastic disposable or tubing supplied by the manufacturer.

The manufacturer should be consulted before blood administered with an infusion pump designed for crystalloid or colloid solutions. Many induce hemolysis but of a magnitude that does not adversely affect the patient. Red cell components with high hematocrit and high viscosity are more likely to be hemolyzed when infused under pressure than whole blood or red cells prepared in a manner that reduces viscosity. Platelets and granulocytes appear to sustain no adverse effects when infused with a pumping device. Proper training of personnel and appropriate policies for maintenance and quality control should reduce the chances of damage to transfused components.

For comments and archives

    An Inspirational Story

Positive thinking

Jerry was the kind of guy you love to hate. He was always in a good mood and always had something positive to say. When someone would ask him how he was doing, he would reply, “If I were any better, I would be twins!”

He was a unique manager because he had several waiters who had followed him around from restaurant to restaurant. The reason the waiters followed Jerry was because of his attitude. He was a natural motivator. If an employee was having a bad day, Jerry was there telling the employee how to look on the positive side of the situation.

Seeing this style really made me curious, so one day I went up to Jerry and asked him, “I don’t get it! You can’t be a positive person all of the time. How do you do it?” Jerry replied, “Each morning I wake up and say to myself, Jerry, you have two choices today. You can choose to be in a good mood or you can choose to be in a bad mood.’ I choose to be in a good mood. Each time something bad happens, I can choose to be a victim or I can choose to learn from it. I choose to learn from it. Every time someone comes to me complaining, I can choose to accept their complaining or I can point out the positive side of life. I choose the positive side of life.” “Yeah, right, it’s not that easy,” I protested.

“Yes it is,” Jerry said. “Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people will affect your mood. You choose to be in a good mood or bad mood. The bottom line: It’s your choice how you live life.”

I reflected on what Jerry said. Soon thereafter, I left the restaurant industry to start my own business. We lost touch, but often thought about him when I made a choice about life instead of reacting to it. Several years later, I heard that Jerry did something you are never supposed to do in a restaurant business: he left the back door open one morning and was held up at gunpoint by three armed robbers. While trying to open the safe, his hand, shaking from nervousness, slipped off the combination. The robbers panicked and shot him. Luckily, Jerry was found relatively quickly and rushed to the local trauma center. After 18 hours of surgery and weeks of intensive care, Jerry was released from the hospital with fragments of the bullets still in his body. I saw Jerry about six months after the accident. When I asked him how he was, he replied, “If I were any better, I’d be twins. Wanna see my scars?”

I declined to see his wounds, but did ask him what had gone through his mind as the robbery took place. “The first thing that went through my mind was that I should have locked the back door,” Jerry replied. “Then, as I lay on the floor, I remembered that I had two choices: I could choose to live, or I could choose to die. I chose to live.”

“Weren’t you scared? Did you lose consciousness?” I asked. Jerry continued, “The paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the emergency room and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read, ‘He’s a dead man.’ I knew I needed to take action.”

“What did you do?” I asked.

“Well, there was a big, burly nurse shouting questions at me,” said Jerry. “She asked if I was allergic to anything. ‘Yes,’ I replied. The doctors and nurses stopped working as they waited for my reply… I took a deep breath and yelled, ‘Bullets!’ Over their laughter, I told them, ‘I am choosing to live. Operate on me as if I am alive, not dead.”

Jerry lived thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully. Attitude, after all, is everything.

For comments and archives

  Cardiology eMedinewS

Optimal ICD programming for primary prevention Read More

High BP likely to be undiagnosed in young adults Read More

  Pediatric eMedinewS

AAP releases new C. diff guidance Read More

High-flow nasal cannulae help extubated preemies Read More

    IJCP Special

Dr Good Dr Bad

Situation: The A1c status of a diabetic worsened in winter.
Dr Bad: It has nothing to do with winter.
Dr Good: Diabetes may worsen in winter.
Lesson: A prospective study of glycemic control during holiday time in type 2 diabetic patients demonstrated an influence of winter holidays on the glycemic control of these patients. The poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearly A1c gain during the winter holidays are likely to contribute to the substantial increase in A1c that occurs every year among type 2 diabetic individuals (Source: Diabetes Care 2004;27(2):326–30)

Make Sure

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn’t you observe the IV site carefully.
Lesson: Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe interstitial necrosis.

  Quote of the Day (Dr GM Singh)

You see things and you say, 'Why?' But I dream things that never were and I say, 'Why not?: George Bernard Shaw

    Legal Question of the Day (Dr M C Gupta)

(NOTE--This version includes inputs provided by DR. M. NARAYANA REDDY)

Q. What is a medical board and what is its significance? Who appoints it? Who can be the members? What are the eligibility criteria? Can a Company/PSU appoint a Medical Board for their employees? Will a Medical Board consisting of “the Bank’s Medical Officer, Specialist in the field and a Physician of repute” be valid in a court of law? Can non-medical persons (cardiac nurse, psychologist, physiotherapist etc.) or AYUSH physicians be members of the board?


  • A medical board simply means a committee or group of doctors appointed formally for a particular purpose, usually to give opinion or advice. It usually has 3 or more persons.
  • The significance of a medical board is as follows:
    • It reflects pooled wisdom and hence minimizes bias.
    • It reflects the opinion of persons from different medical specialties relevant to the case/patient concerned. A diabetic patient may have been operated. The medical board may consist of a physician, a surgeon and an anesthetist. Any one of these individuals working alone would obviously not be competent to give opinion about negligence etc.
    • A board’s opinion is much more likely to be viewed by the court as an independent opinion and hence more reliable than the defence rendered by the defendant or even the expert opinion procured by him privately from an expert.

      In general, the main purpose of constituting a Medical Board is to give more credibility and acceptability to the medical findings/opinion about the medical case concerned
  • The appointing authority for a medical board may vary according to the nature of the board. For example: The Head of the Specialty Department of the Institution can constitute a Medical Board consisting of the members of his department in certain cases, if he is asked by his superior to give opinion in a certain matter; The Head of the Institution can constitute the Medical Board, with the experts drawn from different specialties of that institution, when the matter needs to be examined by the experts from different specialties. The Director, Health Services of the State can constitute a Medical Board consisting of experts drawn from different institutions in the state.
  • There are no hard and fast rules regarding the constitution of a Medical Board, except that if a medical board is constituted under a particular law, rule or guideline, then the criteria prescribed in that law, rule or guideline must be followed. Otherwise, a person authorized to appoint a medical board can do so using his own common sense and discretion.
  • A board consisting of “the organization’s Medical Officer; Specialist in the field; and a Physician of repute” should be OK legally (unless it is violative of the rules applicable to the organization) or if appointed by any Company/PSU/Bank.
  • As regards whether a non-MBBS person can be a member of a medical board, there is nothing against it. The decision depends upon the facts and circumstances of the case.
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

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    Mind Teaser

Read this…………………

The nurse applies mafenide acetate (Sulfamylon cream) to Clara, who has second and third degree burns on the right upper and lower extremities, as ordered by the physician. This medication will:

A. Inhibit bacterial growth
B. Relieve pain from the burn
C. Prevent scar tissue formation
D. Provide chemical debridement

Yesterday’s Mind Teaser: Clara, a burn client, receives a temporary heterograft (pig skin) on some of her burns. These grafts will:

A. Debride necrotic epithelium
B. Be sutured in place for better adherence
C. Relieve pain and promote rapid epithelialization
D. Frequently be used concurrently with topical antimicrobials.

Answer for Yesterday’s Mind Teaser: C. Relieve pain and promote rapid epithelialization

Correct answers received from: Dr PC Das, Dr BB Gupta, Dr Bharat Bhushan Aggarwal, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Thakor Hitendrsinh G, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr KV Sarma, Dr Avtar Krishan, Dr PK Sahu.

Answer for 3rd January Mind Teaser: A. Telling him to avoid heavy lifting for 4 to 6 weeks

Correct answers received from: Dr KV Sarma, Dr Avtar Krishan, Dr Shashi Kumar, Dr C Mohan, Taiyab Saherwala.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Old age secret

Grandpa was celebrating his 100th birthday and everybody complimented him on how athletic and well-preserved he appeared.

"Gentlemen, I will tell you the secret of my success," he cackled. "I have been in the open air day after day for some 75 years now."

The celebrants were impressed and asked how he managed to keep up his rigorous fitness regime.

"Well, you see my wife and I were married 75 years ago. On our wedding night, we made a solemn pledge. Whenever we had a fight, the one who was proved wrong would go outside and take a walk."

    Medicolegal Update

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

Medical Testimony of Doctor in the Court of Law (Contd.)

Do not misrepresent documents/medical literature in the Court of Law

When evidence is read into the record of a trial, only that portion of the document which validates the information being discussed needs to be read aloud. One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point you are making. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time–consuming. 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.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Winter blood pressure 5 mm Hg higher than summer blood pressure

The systolic (top number) and diastolic (bottom number) blood pressures rise and fall with the change of seasons, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & Vice President Elect IMA.

In a study by the Institute National de la Sante et de la Recherche Medicale of Paris and published in the journal Archives of Internal Medicine involving 8801 people aged 65 or older, average systolic blood pressure was five points higher during the winter than in summer.

Instances of high blood pressure (systolic blood pressure higher than 159, or diastolic higher than 94 mmHg) in the study were found in 33.4 percent of participants during winter but just 23.8 percent during summer.

The reason could be related to the baroreflex, a mechanism of blood pressure regulation that is modified in elderly subjects or a function of the sympathetic nervous system, which helps control involuntary actions such as stress response. A 5 mm change in blood pressure can explain why more heart patients die in winter.

    Readers Response
  1. Dear Sir, Emedinews is very informative. Regards: Dr Shradha
    Forthcoming Events

4th eMedinews Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013 (8 AM to 8 PM).

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Eminent Faculty:

Dr Praveen Chandra (Cardiology)
Dr NK Bhatia (Transfusion Medicine)
Dr Ambrish Mithal (Diabetes)
Dr Kaberi Banerjee (Infertility)
Dr Yougal Mishra, Dr Manju Gupta, Dr Somesh Juneja, Dr Deepak Khurana (Valve Surgery)
Dr Rajnish Malhotra (Cardiology)
Dr Vivek Bhatia (GI)
Dr Ashish Jain (Ortho)
Dr Kailash (GI)
Dr Navdeep Chabbra (Beriatric Surgery)
Dr IM Chugh

Register at: www.emedinews.in/


Dr Pawan Gupta, Past President IMA Haryana, Organizing Secretary

4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

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

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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