Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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 November 2012, Monday

PCI Often Done at Low-Volume Centers

25% of all percutaneous coronary intervention in the U.S. is performed at low-volume centers that do 200 or fewer procedures per year. 49% is done at centers that do no more than 400 such procedures annually, Gregory Dehmer, MD, of Scott & White Healthcare in Temple, Texas, and colleagues reported in the Journal of the American College of Cardiology. They also found that on-site cardiac surgery wasn't available at 83% of centers that did 200 or fewer PCIs annually. 2011 PCI guidelines stated that facilities doing 200 or fewer PCIs per year need to take a closer look at whether they should continue doing such procedures.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Even when large volumes are ingested, PEG induced diarrhoea is associated with minimal electrolyte losses or gains. PEG 3350 electrolyte solutions are thus safer than osmotic salts such as magnesium and sodium sulphate or phosphate, especially in patients with impaired renal or cardiac function. Attar A, Lémann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44(2):226

For More editorials…

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)

Seminar on Chronic Constipation

A seminar on Chronic Constipation was organized by eMedinewS , IJCP and Heart Care Foundation of India at Constitution Club of India as part of 19th MTNL Perfect Health Mela celebrations. Panelists were Dr Ajay Kumar, Dr Rajiv Khosla, Dr SK Thakur, Dr AK Jhingan, Dr Kailash Singla. The seminar was moderated by Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, Dr KK Aggarwal

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

Live Recording of Health Interactive Program
With Dilli Aajtak
Date: 5th November, Monday
Venue: Birla Vidya Niketan, Sector - IV, Pushp Vihar, New Delhi
Time: 12 Noon
Anchor: Mr. Pratik Trivedi
Topic: Cardiac First Aid
Telecast time: 8th November, 9 pm
Faculty: Dr KK Aggarwal, Dr HK Chopra, Dr Viveka Kumar

Live Chat with Dr KK Aggarwal
on www.itimes.com
Topic: Cardiac First Aid
Date: 5th November, Monday 2012
Time: 3.00pm - 4.00 pm

My Profession My Concern

Quality control

Repair of vaginal and perineal tears:

  • Scientific evidence proved that superficial tears do not require any repair, because the outcome was the same whether or not such a tear was sutured.
  • The ANM should be able to recognize a superficial tear, and should be able to distinguish it from deeper tears. She should simply apply pad and pressure on the tear.
  • For second and third degree tears which require repair, the ANM should refer the woman to a higher facility.
  • The Staff Nurse should be allowed to repair a second degree tear at the PHC setting, under the supervision of the Medical Officer. But she too should refer third degree tears after vaginal packing.
  • It was decided that the medical officer and the staff nurse require to be trained in repairing tears, and the ANM requires training in recognizing the degree of tear.
  • No additional material/items thus need to be added to the ANM kit for the repair of vaginal/perineal tears.

For More editorials…

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 undergoing mitral repair without mitral valve prolapse who have mild to moderate TR and tricuspid annular dilatation or pulmonary hypertension

(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 More editorials…

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Diabetes mortality in youth has dropped, but concern remains

The diabetes death rate among youths dropped by 61% between 1968 and 2009, according to a new report from the Centers for Disease Control and Prevention published in the November 2 issue of the Morbidity and Mortality Weekly Report. (Source: Medscape)

For comments and archives

Mouthwash with antidepressant cuts mucositis

A mouth rinse containing the tricyclic antidepressant doxepin appears to relieve mucositis pain among patients with head and neck cancers better than plain water, researchers here. Within 15 minutes, pain assessed on a visual analog scale dropped 1 point with water and 2 points with doxepin, Robert Miller, MD, professor of medicine at the Mayo School of Medicine in Rochester, Minn., said at the American Society for Radiation Oncology (ASTRO) meeting. (Source: Medpage Today)

For comments and archives

Change in kidney markers not just function of age

Both a low estimated glomerular filtration rate and high albuminuria are associated with end-stage renal disease and death at all ages and are not just part of the aging process, researchers found. (Source: Medpage Today)

For comments and archives

Night-shift work ups the risk for various cancers in men

Men working at night had approximately double the risk of those who did not work the night shift for many different cancers, according to a Canadian case–control study published in November 1 issue of the American Journal of Epidemiology. (Source: Medscape)

For comments and archives

RF ablation, antiarrhythmic meds comparable as initial therapy of paroxysmal AF

Radiofrequency (RF) ablation as first-line therapy for paroxysmal atrial fibrillation (AF) was no more effective than antiarrhythmic therapy in a two-year trial conducted in Scandinavia. (Source: Medscape)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: WATCH CPR 10 - Dr KK Aggarwal:
http://www.youtube.com/watch?v=WTsc4OjA1X4&list=ULWTsc4OjA1X4 … via @youtube

@DrKKAggarwal: Spirituality is not a contrived mood or behavior but a simple unaffected humanity.

    Spiritual Update

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

Changing Dharma in the Ceiling Period

In Vedic language the word dharma means to “hold”. Whatever in behaviour, happening, conducts or thought, holds people together, is said to be the dharma of the society. The definition of dharma, therefore, is likely to change overtime depending upon the collective consciousness of the people living in that society. These changes have been responsible for formation of various religions all over the world.

For comments and archives

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

Assisted hatching is recommended for which patients?

The use of assisted hatching in all patients is not recommended. Assisted hatching should be reserved for patients who may have a harder time achieving pregnancy (poor diagnosis). This includes women who are 38 years old or older using their own eggs, patients with 2 or more failed IVF cycles, and those who had been noted to have poor embryo quality.

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

Tests must be performed to ensure:

Safe administration of donor blood to patient

Have a pregnancy as safe as possible for both mother and child.

For comments and archives

    An Inspirational Story

Your Heart's Desire

One night, a young woman dreamed she was walking in the mall and noticed a shop on the second floor she hadn't seen before. The name over the door said, "Your Heart's Desire".

She crossed the store's threshold and was enveloped in a charming fragrance. The store had a homey feeling, with shelves full of fascinating items. A short, smiling dumpling of a lady was behind the counter.

"What is it your shop sells?" asked the young lady.

"Just as the name implies, everything your heart desires!" came the purring answer.

"Oh! I know what I want!" exclaimed the girl, "Peace, happiness, love for everyone, and..."

"Wait a minute," giggled the cashier. "You don't quite understand. We sell whatever your heart desires. But we don't sell the finished product, we sell the seeds -- and you have to choose the ones you want to plant."

For comments and archives

  Cardiology eMedinewS

RF Ablation, Antiarrhythmic Meds Comparable As Initial Therapy Of Paroxysmal AF Read More

Xarelto Wins Nod for Pulmonary Embolism, DVT Read More

  Pediatric eMedinewS

Change In Kidney Markers Not Just Function Of Age Read More

Use Of SSRIS In Pregnancy Puts Baby At Risk Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with postpartum fever was not responding to broad–spectrum antibiotics.
Dr Bad: Change the antibiotic.
Dr Good: Get a CT scan done.
Lesson: Non–responding postpartum fever could either be due to a pelvic abscess or pelvic thrombophlebitis. A CT scan can detect the abscess.

For comments and archives

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh My God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

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.

Q. What should be done as regards the existing PC&PNDT Act?


  • Low sex ratio in India is a real issue that needs to tackled directly through a PC&PNDT Act in addition to the other measures described above. For this purpose, the existing Act needs to be radically amended on the following lines.
  • The preamble of the Act should be changed to:

    “An Act aimed at improving the low sex ratio in India by prohibition of sex selection before conception and by regulation of pre-natal diagnostic techniques in such a manner as to prevent female foeticide and to promote survival of the female child and for matters connected therewith or incidental thereto.”
  • The focus of the Act should be changed from prohibition of prenatal sex detection to prohibition of female foeticide and ensuring survival of the unborn child.
  • There should be no restriction on conducting a “prenatal diagnostic procedure” or “prenatal diagnostic technique” or “prenatal diagnostic test” except that such procedure or technique or test should be permitted to be conducted by a registered “genetic clinic” or “genetic counselling centre” or a “genetic laboratory” only on the written advice and referral by a gynaecologist or registered medical practitioner treating the patient or person who would, before such referring, inform the Appropriate Authority about such referral and would obtain from the AA code number which the AA would allot and transmit to the gynaecologist or registered medical practitioner in respect of such patient or person through a quick transmitting device such as a mobile phone SMS. It would be the responsibility of the gynaecologist or registered medical practitioner concerned to inform the AA about the details regarding the patient or the person and the procedure, technique or test etc. to the AA within 72 hours by e mail/online as per a prescribed for, say Form One.
  • The above would apply even in the case of self -referral, meaning thereby that when the person referring and performing the procedure etc. is one and the same, even then a code number must be obtained. This means that if a gynaecologist having her own ultrasound centre registered under the PC&PNDT Act wishes to perform an ultrasound on a pregnant woman, she would first obtain a code number and then perform the procedure etc.
  • The code number generated as above should be linked to a reliable identification marker such as the Aadhar no. or the voter identity no. etc.
  • It would be the responsibility of the AA to do as follows:
    • To ensure that a “prenatal diagnostic procedure” or “prenatal diagnostic technique” or “prenatal diagnostic test” etc. is performed by any registered “genetic clinic” or “genetic counselling centre” or a “genetic laboratory” only on the basis of the code number as described above.
    • To ensure that the report of the above procedure etc. is communicated to the AA online by the concerned clinic etc. The government should ensure that a mechanism is established whereby each ultrasound machine is connected online so that the ultrasound report in respect of each pregnant woman is transmitted to the AA automatically.
    • To ensure that the AA follows up each pregnant woman in respect of whom a code is generated or a genetic procedure etc. is performed till the termination of pregnancy by delivery or otherwise and to investigate the cause of such termination other than through delivery. The government should ensure that a mechanism is established whereby the AA can monitor throughout pregnancy each pregnant woman in respect of whom a code number has been generated. This would need appropriate linkage with the CMO where the AA is not the CMO.
  • Immediately on allotment of a code number, the government should, in association with an insurance company, cause to be issued a mediclaim type of health policy to the pregnant woman which would guarantee adequate and proper health coverage for the mother and the baby throughout pregnancy and for 12 months after childbirth. The cost of the policy should be borne by the government.
  • There should be no restriction on sale or purchase of an ultrasound machine.
  • In the above scheme of things, there would be no need to prohibit detection or communication of the sex of the unborn. The only requirement would be that if the sex of the unborn is detected, it should be informed to the AA and that the AA should specifically and intensively monitor such cases to detect/prevent/punish instances of selective female infanticide.
  • The government may consider implementing other measures aimed at survival of the unborn female child, such as the following:

    ONE--Every person performing a USG on a pregnant woman and reporting the sex as female should be promised Rs. 2000/-, payable on delivery of the female child.

    TWO--Every woman carrying a female fetus should be promised the following: FIRSTLY--A reward of Rs. 5000/-, payable on delivery of the female child.

    SECONDLY---A special FREE LIC policy for the girl child from birth till the age of 18 years.

    THIRDLY--A monthly cash allowance of Rs. 1000/- for the female fetus/girl child till she attains the age of 18 years.

    FOURTHLY--FREE education for the girl up to whatever level she wants to study.

    NOTE—The above measures may, in the first phase, be implemented in the 100 worst districts as regards sex ratio.
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  Quote of the Day (Dr GM Singh)

The alphabet ‘O’ stands for Opportunity which is absent in yesterday, available once in tOday, and thrice in tOmOrrOw, so always think positive about future.

    Mind Teaser

Read this…………………

Ana is diagnosed to have Pernicious anemia. The physician orders 0.2 mg of Cyanocobalamin (Vitamin B12) IM. Available is a vial of the drug labeled 1 ml= 100 mcg. The nurse should administer:

A. 0.5 ml
B. 1.0 ml
C. 1.5 ml
D. 2.0 ml

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s  Mind Teaser: C. Avoid giving him direct information and help him explore his feelings

Correct answers received from: Dr.A.P.Bhatia, Dr.A.P.Bhatia,Dr Chandresh Jardosh,Dr Pankaj Agarawl, Muthumperumal Thirumalpillai, Dr Avtar Krishan,Dr. P. C. Das, Dr. shashi saini, N Prabakar

Answer for 3rd November Mind Teaser: D. Increased pulse rate.
Correct answers received from: Dr Ashok Barat, Dr. Priyaranjan Bhattacharjee, Dilip Ratnani, Dr Jainendra Upadhyay, Dr K P Chandra

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

It was out anniversary and I asked my wife where she wanted to go, she said: "Please take me somewhere I’ve never been before" So, I took her to the kitchen !!!

    Medicolegal Update

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

Human body dies in bits and pieces termed as molecular death

The corneal reflex and papillary reflex disappear at the time of death. The pupil reacts to the drugs like atropine that causes dilatation up to 1 hour. The cornea can be removed for transplant for up to 6 hours and blood can be transfused for up to 6 hours of death. Therefore, we die in bits and pieces.

  • Clinical death implies the failure of the body as an integrated system. For some time afterwards, life continues in the separate tissues, which constitute the body. These only die after varying periods depending upon the ability of the tissue to function without blood supply. This is called molecular or cellular death. The nervous tissue dies rapidly and the vital centers die in about 5 minutes. The muscles live longer and they will constrict to direct electrical stimuli up to 3 hours.
  • The legal definition of death depends upon the diagnosis of somatic death. The distinction between somatic and molecular death becomes important because in order to remove essential tissues and organs for transplantation there is a relatively short time for the biological properties of living matter to persist after somatic death. With somatic death, there is complete generalized anoxia of the tissue and consequently stoppage of metabolic process carried out by the tissue cells.
  • The metabolic process of the ganglion cells stops in minutes, which are most sensitive whereas that of connective tissue stops in hours, which are the least sensitive.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Do not ignore chronic constipation

Do not ignore chronic constipation, especially in the elderly as it may be a sign of underlying cancer, said Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, Dr. Rajiv Khosla and Dr. Praveen Bhatia, in a joint statement.

They were participating in a seminar organized by Heart Care Foundation of India and eMedinewS at Constitution Club of India as part of 19thMTNL Perfect Health Mela celebrations. Over 200 doctors participated in the seminar which was supported by Win Medicare.

The doctors said that any abdominal pain associated with diarrhea should suspect one of inflammatory bowel disease but if the same appears for the first time in the elderly, one must conduct colonoscopy to rule out cancer of gut.

Constipation should not be treated with laxatives as they may be habit forming. Isabgol, triphala and poly ethylene glycol are the commonest medicines used to treat constipation. Isabgol is a bulk laxative. Presence of rectal bleeding, constipation and diarrhea, unexplained abdominal pain should warrant one to undergo colonoscopy.

Facts about chronic constipation

  • Constipation is the most common digestive complaint in the general population, and is associated with substantial economic costs
  • Infrequently, constipation is the first manifestation of metabolic (diabetes mellitus, hypothyroidism, hypercalcemia, heavy metal intoxication), neurologic, or obstructive intestinal disease; more often, it occurs as a side effect of commonly used drug
  • Constipation has been defined as a stool frequency of less than three per week
  • An international working committee recommended diagnostic criteria (Rome III) for functional constipation. The diagnosis should be based upon the presence of the following for at least three months (with symptom onset at least six months prior to diagnosis).

    a. Must include two or more of the following:
  • Straining during at least 25 percent of defecations
    • Lumpy or hard stools in at least 25 percent of defecations
    • Sensation of incomplete evacuation for at least 25 percent of defecations
    • Sensation of anorectal obstruction/blockage for at least 25 percent of defecations
    • Manual maneuvers to facilitate at least 25 percent of defecations (eg, digital evacuation, support of the pelvic floor)
    • Fewer than three defecations per week

      b. Loose stools are rarely present without the use of laxatives
      c. There are insufficient criteria for IBS.
  • It often responds to dietary changes and various laxatives.
  • Idiopathic constipation is associated with normal or slow colonic transit, functional defecation disorder, or both.
  • Management of normal and slow transit chronic constipation includes patient education, behavior modification, dietary change, bulk forming laxatives, and the use of non-bulk forming laxatives or enemas
  • Initial management of idiopathic constipation involve dietary fiber and bulk forming laxatives such as psyllium ormethylcellulose, together with adequate fluids
  • For patients who do not tolerate bulk forming laxatives or respond poorly to fiber one should start with osmotic laxative
  • Other options include stool softeners or stimulant laxatives (bisacodyl, senna, and sodium picosulfate).
  • Management of severe constipation and functional defecation disorder may involve suppositories, biofeedback, botulinum toxin injections into the puborectalis muscle, or subtotal colectomy under specific circumstances.
  • Various pharmacologic therapies (lubiprostone, misoprostol, colchicine) have been used to treat severe constipation with limited success.
  • In patients over the age of 70 years warm water enemas rather than sodium phosphate enemas be used for the treatment of constipation
  • The use of sodium phosphate enemas in older adults has been associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure, and EKG changes (prolonged QT interval).
    Readers Response
  1. Dear Sir, your way of educating people is too good. Regards: Dr Praven
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