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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 …

6th January 2013, Sunday

Revisiting 2012: Tweets of the day @drkkaggarwal

  1. Timely refer to a kidney specialist patients with very low GFR (<15 mL/minute) or very high albuminuria (>300 mg/24 hours).
  2. Metformin is superior to Glipizide for Reducing Cardiac Events in Diabetics with Heart Disease
  3. Heavy smoking can reduce the quality of saphenous veins which are used in coronary artery bypass grafting.
  4. If you are depressed you have more chances of heart attack
  5. If you are above 70, and constipated take warm water enemas rather than sodium phosphate enemas. They can be harmful.
  6. If you are above 65 with normal or slightly low bone mass (T-score -1.01 to -1.49) at baseline measurement and no risk factors for accelerated bone loss have a follow-up DXA BMD only after 10 to 15 years
  7. Are you on statins, get only baseline SGTP, SGPT done. Routine monitoring is not necessary.
  8. R U on citalopram for anxiety or depression, do not take > 40 mg per day as it can cause dose-dependent QT interval prolongation.
  9. R U on citalopram for anxiety or depression, do not take > 40 mg per day as it can cause dose-dependent QT interval prolongation.
  10. R u on citalopram, over 60, liver disease do not take a dose > 20 mg
  11. Taking a statin can raise blood sugar and HbA1c levels says FDA
  12. American College of Physicians: assess risk for colorectal cancer in all adults aged 50 years and older.
  13. US Preventive Services Task Force: do not opt for routine PSA based prostate cancer screening for healthy men, regardless of age.
  14. A Soda a Day Raises CHD Risk by 20% [March 12 in Circulation] 15. 2 Obesity Drugs approved in 2012 in US: Lorcaserin and Phentermine-topiramate

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

    Constipation Update

What is the role of lactulose in constipation?

Lactulose increases stool frequency, decreases the severity of constipation symptoms and reduces the need for other laxatives in older adult patients. However, in one study, lactulose was less effective than low–dose polyethylene glycol (PEG) and also had a higher incidence of flatus (Gut 1999;44(2):226–30). In another study, PEG 3350 compared with lactulose provided a higher success rate with fewer side effects (Gut 2004 Nov;53(11):1590–4).

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Ventilator-associated tracheobronchitis

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal in IMA with Mr Ram Madhav of RSS

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

Police files case against #Zee for revealing identity of #Nirbhayas friend 4 disclosing his identity Legal position concerned laws

Disclosure of the identity of a patient: The confidentially law is mentioned in the IPS 228A (INDIAN PENAL CODE, 1980) As under:

228A. (10) (Disclosure of identity of the victim of certain offences, etc.-

  • Whoever prints or publishes the name or any matter which may make known the identity of any person against whom an offence under section 376, section 376A, section 376B, section 376C or section 376D is alleged or found to have been committed (hereafter in this section referred to as the victim) shall be punished with imprisonment of either description for a term which may extend to two years and shall also be liable to fine.
  • Nothing in sub- section (1) extends to any printing or publication of the name or any matter which may make known the identity of the victim if such printing or publication is-
    • By or under the order in writing of the officer- in- charge of the police station or the police officer making the investigation into such offence acting in good faith for the purposes of such investigation; or
    • By or with the authorization in writing of, the victim; or
    • where the victim is dead or minor or of unsound mind, by, or with the authorization in writing of, the next- of- kin of the victim: Provided that no such authorization shall be given by the next- of- kin to anybody other than the chairman or the secretary, by whatever name called, of any recognised welfare institution or organization. Explanation.- For the purposes of this sub- section," recognised welfare institution or organization" means a social welfare institution or organization recognised in this behalf by the Central or State Government.
    • Whoever prints or publishes any matter in relation to any proceeding before a court with respect to an offence referred to in sub- section (1) without the previous permission of such court shall be punished with imprisonment of either description for a term which may extend to two years and shall also be liable to fine. Explanation.- The printing or publication of the judgment of any High Court or the Supreme Court does not amount to an offence within the meaning of this section.)

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

When is antithrombotic therapy indicated after heart valve replacement?

Treatment with warfarin (or other vitamin K antagonist) and/or aspirin is recommended in patients with prosthetic heart valves to prevent valve thrombosis and thromboembolic events.

(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)

No extra death risk seen for moderate obesity

Only people with body mass index values of 35 or higher face a significantly higher risk of early death than normal-weight individuals, a large meta-analysis suggested. (Source: Medpage Today)

HCV studies give hope for interferon-free therapy

Investigational agents that act directly against the hepatitis C virus (HCV) may allow previously untreated patients to avoid interferon therapy, long a standard of care, researchers said. (Source: Medpage Today)

Different sugars have different effects on brain

Glucose appears to tamper brain activity in regions that regulate appetite and reward -- but fructose does not, researchers found. In a brain imaging study, participants who had a drink sweetened with glucose had significant reductions in cerebral blood flow in the hypothalamus, while those who drank a fructose-sweetened drink saw a slight increase in activity (P=0.01), Robert Sherwin, MD, of Yale University, and colleagues reported in the Jan. 2 issue of the Journal of the American Medical Association. (Source: Medpage Today)

Renal failure hikes mortality with LVADs

Among patients receiving a left ventricular assist device (LVAD) for end-stage heart failure, developing acute renal failure after implantation predicted a lower likelihood of surviving the next year, a single-center study showed. (Source: Medpage Today)

Urinary incontinence and menopause unlinked?

Menopause may have little, if any, effect on the risk for urinary incontinence (UI), according to an epidemiologic review published online October 29 and in the January 2013 issue of Maturitas. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Corruption is taught as 3c of marketing, convince, confuse or corrupt. Teachers need to redefine their teachings.

@DeepakChopra: Is there any way to get over the fear that comes after losing a parent? http://tinyurl.com/bnc7cm6

    Spiritual Update

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

If You Are Not Getting Married, Why To Go To Vaishno Devi Or Any Other Sacred Temple

When you are confused or having lack of ideas, you need a break. In computer language, when the computer hangs up, you shut off the computer, give it some time to rest and then restart. In mythology, this is called ‘incubation period’.

For comments and archives

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

How does ICSI work?

The sperm are mixed with the woman's egg in a laboratory. If ICSI is needed, a small needle is used to inject a sperm into the center of the egg. The fertilized egg grows in a laboratory for 1 to 5 days and then it is placed in the woman's uterus (womb).

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

(Dr Sanjay Chaudhary, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre)

Q. Is there any use of corneas that are for some reason not utilized for surgery?

A. Corneas that are rejected for technical reasons may be used for research or education purposes.

    An Inspirational Story

Benefits of Struggling

A man found a cocoon of a butterfly. One day a small opening appeared, he sat and watched the butterfly for several hours as it struggled to force its body through that little hole.

Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no farther. Then the man decided to help the butterfly, so he took a pair of scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily.

But it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time.

Neither happened!

In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings.

It never was able to fly.

What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were God’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon.

Sometimes struggles are exactly what we need in our life. If God allowed us to go through our life without any obstacles, it would cripple us. We would not be as strong as what we could have been.

And we could never fly.

For comments and archives

    Cardiology eMedinewS

Pulmonary Artery Denervation Works For Refractory PAH Read More

DES for Vascular ED Read More

    Pediatric eMedinewS

AAP: All Work and No Play Bad For Kids Read More

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic elderly came with low HDL levels.
Dr Bad: In elderly it is of no significance.
Dr Good: It is an important risk factor.
Lesson: Lower HDL cholesterol is an important risk factor for not only IHD but also CVD, especially in diabetic elderly individuals (Diabetes Care 2009;32(7):1221–3).

Make Sure

Situation: A 28–year–old male presented with increased frequency and occasional blood in urine. Examination of urine showed sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. Sterile pyuria is the first clue to diagnosis.

    Legal Question of the Day (Dr MC Gupta)

What are the pros and cons of death penalty? Which method of execution is best?

Q. What are the pros and cons of death penalty? Which method of execution is best?


  • The simple answer is that courts award death sentence because they are obliged to do so by law. Courts have to follow law.
  • As per criminology, there are supposed to be three main reasons for awarding death sentence:
    • Mainly, the death sentence is awarded as retribution for a heinous crime, usually involving killing somebody. This concept is clearly reflected in the “eye for an eye” concept of the medieval days. Gandhi had this to say about it-- “If we follow the axiom an eye for an eye, we would all be blind”.
    • Another reason is that the person is considered to be so dangerous to society that the society will not be safe if he is allowed to live.
    • A third reason is that death sentence given to criminals will act as a deterrent for others in the society.
  • Aguments against death penalty are as follows:
    • Moral argument—There is a reasoned view that when man cannot give life, he has no right to take away life. Man should not interfere in god’s domain.
    • There are often no clear cut guidelines regarding whom to award death sentence. As per Indian law, it has to be given in rarest of rare cases. In practice, it is not defined what is “rarest of the rare”. Courts act rather arbitrarily in arriving at such decision.
    • Court verdicts are not fool-proof. Innocents may be given death penalty by the courts. Death sentence given by a lower court may be dispended with by a higher court. However, innocence may be discovered after a long time. If the person has already been hanged, he can’t be brought back to life even if proved innocent. There are several examples of this happening. A well- known example is that of Dr Hawley Crippen who was hanged in 1910, after an Old Bailey jury took just 27 minutes to find him guilty of murdering his wife, Cora, who had vanished earlier that year. A hundred years later, DNA studies revealed that the corpse found in his cellar could not have been that of Cora. Dr. Crippen maintained till the end that he was innocent. http://www.guardian.co.uk/uk/2007/oct/17/ukcrime.science
    • The legal defence available to the accused / defendant, especially when he is from a low socio-economic background, is often of poor quality and hence acts against him. It has been said that the competence of the defence attorney "is a better predictor of whether or not someone will be sentenced to death than the facts of the crime themselves". It is well proven by data that the proportion of adult US population in jails, including those condemned to death, is much higher in case of blacks and Hispanics.
    • The individual who is executed may not be himself responsible for his deed. The real culprits are the society and the social circumstances that made a criminal out of him. There might even be genetic factors at work.
    • With increased use of laboratory investigative techniques, punishment is often awarded on the basis of laboratory reports. Such reports may be faulty. Examples are as follows:
      • In West Virginia, a serologist falsified test results in hundreds of cases over a ten-year period, sentencing hundreds of defendants to lengthy prison terms.
      • In Texas, a pathologist faked autopsy results, resulting in as many as 20 death penalty verdicts.
      • A police chemist elsewhere falsified reports and sent hundreds of innocent people away to jail on rape charges.

      For comments and archives

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

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    Quote of the Day (Dr GM Singh)

Keep your dreams alive. Understand to achieve anything requires faith and belief in yourself, vision, hard work, determination, and dedication. Remember all things are possible for those who believe. Gail Devers

    Mind Teaser

Read this…………………

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.

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: A. Inhibit bacterial growth

Correct answers received from: Dr Monica Gandhi, Dr Arpan Gandhi, Dr Kiran Aggarwal, Dr KV Sarma, Dr (Maj. Gen.) Anil Bairaria, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr BK Agarwal, Dr U Gaur.

Answer for 3rd January Mind Teaser: C. Relieve pain and promote rapid epithelialization

Correct answers received from: Dr (Maj. Gen.) Anil Bairaria, Dr BK Agarwal.

Send your answer to ijcp12@gmail.com

   Laugh a While (Dr GM Singh)

Preacher's Wish from God

A preacher went into his church and he was praying to God. While he was praying, he asked God, "How long is 10 million years to you?" God replied, "One second." The next day the preacher asked God, "God, how much is 10 million dollars to you?"

And God replied, "A penny." Then finally the next day the preacher asked God, "God, can I have one of your pennies?" And God replied, "Just wait a sec."

    Medicolegal Update

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

WMA declaration of Malta on hunger strikers

Such difficult ethical situations in medical practice and the guidelines to deal with them have been addressed thoroughly in the revised WMA Declaration of Malta on hunger strikers with principles of Duty to act ethically, in 2006. All physicians are bound by medical ethics in their professional contact with vulnerable people, even when not providing therapy. Whatever their role, physicians must try to prevent coercion or maltreatment of detainees and must protest if it occurs. The other important component is respect for autonomy. Physicians should respect individuals’ autonomy. This can involve difficult assessments as hunger strikers’ true wishes may not be as clear as they appear. Any decisions lack moral force if made involuntarily by use of threats, peer pressure or coercion. Hunger strikers should not be forcibly given treatment they refuse. Forced feeding contrary to an informed and voluntary refusal is unjustifiable. Artificial feeding in form of intravenous fluid/nutrition with the hunger striker’s explicit or implied consent is ethically acceptable.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Have Leg Artery Blockages? Walk on a Treadmill

A planned program of walking is good for people with blockage of leg blood vessels called peripheral arterial disease (PAD) said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & Vice President Elect IMA.

Normally when there is pain in the calf muscles in the leg on walking, the usual tendency is to rest and not walk. A study of 156 people with PAD published in JAMA showed that regular six-minute walks on a treadmill improved their endurance and quality of life. The study examined patients with symptoms and without symptoms. Over the six months of the study, the participants who did their regular six-minute treadmill walks increased their walking distance by about 69 feet, while those who did not walk regularly saw a decrease of 49 feet.

There is the potential for greater oxygen extraction from the blood under maximum exercise conditions. The muscles can make better use of blood flow and the oxygen release that comes from it.

Such exercise leads to improvement in "collateral circulation" -- growth in the number of blood vessels supplying the legs. Clinicians should urge all PAD patients, whether or not they have symptoms, to engage in a regular, supervised exercise program.

Walking is a standard recommendation for people with PAD. A recommended regimen is a 40-minute walk three times a week for at least six months.

Persistent leg pain is an indication that help is needed. In the absence of that symptom, physicians can test for PAD by measuring the difference in blood pressure between an ankle and an arm.

    Readers Responses
  1. Dear Sir, Emedinews is really very informative. Regards: Dr Shipra
    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 Singla (GI)
Dr Navdeep Chabbra (Beriatric Surgery)
Dr IM Chugh (Pulmonoagy)
Dr AK Dhar (Hemato oncology)

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

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