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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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eMedinewS Presents Audio News of the Day

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

Photos of Doctor’s Day Celebration

    Health Videos …

Nobility of medical profession: Aamir Khan Controversy (Video 1 to Video 9)
Health and Religion: Bharatiya Vidya Bhavan and Heart Care Foundation of India(Video 1 to Video 7)
Take Care Holistically, DD India health series, Anchor Dr KK Aggarwal (Video 1–3)
Chat with Dr KK On life Style Disorders

Health Update (Video 1 to 15)

  Editorial …

6th August 2012, Monday

Potassium Tricks

  • Dealing with hemolysed sample: One can get a hemolyzed sample, where the serum on top of the clot may artificially have an increase in potassium owing to lysis of cells. It is not possible to assess the quantity of potassium when it is hemolyzed, so you always have to repeat the sample.
  • When the platelet count is high: There are issues of thrombocytosis in a platelet count above 5 00,000 cells/µL. If it participates in the clotting process (in a red-top tube), then what lies on top of it (the serum) will have a higher potassium concentration.
  • Serum or plasma: If the potassium level is high, then both serum and plasma potassium should be measured. If the platelet count is up, one can see a 0.3- to 1-mEq/L difference between serum (higher) and plasma (lower). Remember that plasma would be a purple top or a green top.
  • High K (> 6) get ECG done: Never ignore high potassium. Get an ECG to see whether it is really a problem. An ECG can show you that it is not cardiotoxic.
  • Look for aldosterone blockers (spironolactone or eplerenone). The RALES data showed that patients in systolic forms of heart failure with an average dose of about 25 mg of spironolactone clearly had more frequent hyperkalemia. When you start spironolactone, you should make an assessment of the risk factors for an inordinate increase in potassium. You are going to look at the glomerular filtration rate (GFR) and try to estimate the prevailing intake, the fluid status of the patient, other medicines that may influence potassium, and the sampling conditions in which you can obtain it. There is a finite rise that occurs. Not everyone goes up 2 mEq/L. An average increase might be 0.5-1.2 mEq/L, so if you start out at 4 mEq/L, you are in a safe range. If you start at 4.5 mEq/L, you are beginning to run into the chance that you may get closer to 6 mEq/L, which would be a problem area. If you are at 4.8 mEq/L, then that is going to dictate earlier surveillance.
  • How soon should K levels be checked after starting aldosterone blockers? If you have a reduction in GFR to start with, somewhere between 3 and 7 days would be reasonable.
  • Is eplerenone better? This has never been studied. But it is safer. Someone is given 25 mg of spironolactone. The patient becomes unnecessarily hyperkalemic. The potassium level goes to 5.7 mEq/L. You decide to make a switch to eplerenone, one can start on eplerenone 25 mg twice daily.
  • What about low K levels: Treatment of low K levels is a tricky issue. One should determine the threshold below which you want to treat. If it is a clearly reversible cause, short-lived in nature, and you could remedy it, then you may not need the supplement. Or it might be something more permanent in nature. One may be dealing with potassium-wasting disorders that occur sometimes with gentamicin therapy with certain cisplatin chemotherapy agents, in which case you are obligated to keep treating almost for perpetuity. If you are going to be on diuretic therapy persistently, you take certain steps, you limit the salt intake, and you limit the dose of the agent in question. If you have to give a potassium supplement, you give potassium chloride rather than potassium acetate or potassium citrate.
  • Why limit salt? Sodium exposure to the distal tubule creates the need to absorb, creating an intraluminal electronegativity in the distal tubule. Because potassium is a cation, it is secreted down an electrochemical gradient. If you limit sodium, there is less sodium to resorb, less electronegativity in the distal tubule, and less potassium loss or kaliuresis.
  • Why magnesium should be measured? In the presence of low magnesium levels, low K will not be corrected
  • When to look for primary aldosteronism? If the patient is on a low-dose diuretic, sodium intake is not that high, and the potassium level is very low -- 3 mEq/L or below -- that is a consideration for checking for aldosteronism.
  • What do you do if you suspect hyperaldosteronism? The screening test is a random plasma aldosterone/renin activity ratio.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  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)

Ek Shaam Sehat Ke Naam

A session on Obesity was held at India Habitat Centre. It was organized by Heart Care Foundation of India in association with All India Radio and India Habitat Centre to mark Doctor’s Day on July 1, 2012

Dr K K Aggarwal
    National News

Battle against TB runs into diabetes hurdle

CHENNAI: Healthcare workers fighting to control tuberculosis face a new challenge : diabetes in TB patients. Studies have found that nearly half the number of patients registered for treatment of infectious tuberculosis in Chennai and neighbouring districts are diabetic. Doctors say diabetes in TB patients will not only make treatment difficult, but make tuberculosis prevention a challenging task.

A team of researchers at MV Hospital for Diabetes screened 827 tuberculosis patients registered under the Revised National Tuberculosis Control Programme (RNTCP) for treatment in Chennai, Tiruvallur and Kancheepuram primary health centres between January and March 2011. The study was published in PLos One, a peer reviewed medical journal. Though TB primary affects the lungs, in some people it may affect the spine, kidney or brain. The study found that one in two TB patients had diabetes or was in the pre-diabetes stage. What doctors found more dangerous was that nearly 50% of those with diabetes and tuberculosis had infectious tuberculosis. "Such patients respond slow to drugs. Unless we cure them, we will not be able to prevent the spread. That's like a time bomb," said MV Hospital chairman Dr Vijay Vishwanathan. It can be deadly, if the person has drug resistance. The growing number of diabetics in India poses a bigger challenge, he said. In June, a research from Copenhagen showed a diabetic is four times more likely to get TB than a healthy person. A diabetic faces five times more risk of death during tuberculosis treatment. REACH director Dr Nalini Krishnan said TB -diabetes could be more dangerous than HIV. "The number of people with diabetes big. If we don't handle the problem now, the situation can be deadly," she said.

According to the union health ministry, 40% of Indians are carriers of TB. In 2009, out of the 9.4 million TB cases across the globe, there were 2 million from India. Studies on diabetes have shown 10% of people across India could be diabetic and in cities like Chennai it could be 20%. "It's now time for us to develop combined treatment plans for patients with diabetes and tuberculosis. This should aim and early diagnosis and treatment," said Dr Vijay. (Source: TOI, 3 Aug 2012)

For comments and archives

Key role of mobile phones in India health services: Ghulam Nabi Azad

LONDON: Mobile phones have become a new tool in the hands of health workers in India to reach out to over 1.2 billion population through innovative techniques, Union Health Minister Ghulam Nabi Azad has said. The Minister told a major summit on Health and Life Sciences here at the British Business Embassy that India had taken several steps to integrate and enhance health related IT systems, such as the Mother and Child Tracking System (MCTS). India's objective, Azad said, was to reposition the mobile phone from a mere communication device to an instrument of empowerment and to use it to help take health care services at the doorstep of ordinary people. K Desiraju, special secretary in the Ministry of Health, told the audience comprising global health leaders that there were over 925 million mobile phone subscribers, which covered most of India's population. This, he said, opened several opportunities for health services. Desiraju cited the example of health workers in Karnataka taking photographs of a new-born baby's eyes immediately after birth and sending the image across to Narayana Nethralaya in Bangalore for assessment for retinopathy. "In six districts in six months, there were 700 surgical interventions of children who would otherwise have become blind. This example struck me as being very important...As a result of using this technology, there is a child who would have gone blind and is now able to see. That is quite remarkable", Desiraju said. (Source: PTI, 3 AUG, 2012)

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

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Spectral mammography measures breast density

Spectral mammography can accurately measure breast density, a risk factor for breast cancer, according to preliminary research presented this week in Charlotte, North Carolina, at the American Association of Physicists in Medicine 54th Annual Meeting. (Source: Medscape)

For comments and archives

New swine flu cases confirmed

The CDC is reporting 12 new cases of human infection with a swine influenza virus, including 10 linked to exposure to pigs at a county fair in Ohio. The new cases of what the agency is calling H3N2v flu bring the total to 29 since the first case of human infection was detected in July 2011, according to Joseph Bresee, MD, of the CDC's influenza division. All told, there have been 17 cases this year, 16 of them in the past few weeks, Bresee told reporters in a telephone news briefing on Friday. Most of the infections are in children and have been linked to either farming pigs or exposure to the animals at fairs. (Source: Medpage Today)

For comments and archives

Salpingectomy for ectopic pregnancy may decrease fertility in some cases

Radical surgery for ectopic pregnancy may decrease the odds of a future spontaneous pregnancy for some women, a new study suggests. Those women are ones with a history of infertility, tubal disease or age above 35, the study found. "There are better fertility rates after conservative strategy, especially for patients with a risk factor of infertility," said Dr. Benoît Rabischong of the Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France and his colleagues in a report online July 18 in Fertility and Sterility. (Source: Medscape)

For comments and archives

FDA greenlights asthma drug generics

Generic forms of the popular asthma drug montelukast sodium (Singulair) produced by 10 manufacturers have won FDA approval, the agency announced. Montelukast is a leukotriene receptor antagonist and, unlike other most other products intended for long-term control of asthma symptoms, is available in oral form. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: 4th Dil Ka Darbar on 23rd September, 2012http://twitpic.com/aeznf9

@DrKKAggarwal: Is my existential crisis a reaction to my awareness or just my ego struggling for survival

    Spiritual Update

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

Lust in Mythology

Kaam, Krodha, Lobha, Moha and Ahankara are the five basic slow poisons mentioned in mythology with lust being number one. Lust and spirituality do not go together. In Bhagavad Gita Lord Krishna says that lust, if unfulfilled is the gateway for anger and anger leads to disorders of the intellect.

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)

4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More

The 4th Asia Pacific Vascular Interventional Course begins Read More

Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More

4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More

Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty
Read More

4th Asia pacific vascular intervention course Read More

4th Asia pacific vascular intervention course paper clippings Read More

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What precautions should be carried while carrying a multiple pregnancy?

Metabolic and nutritional considerations: There is an increased need for maternal nutrition in multiple pregnancies. An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. With multiples, weight gain of approximately 45 pounds is optimal for normal weight women. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.

Activity precautions: Women with multiple pregnancies are usually advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may increase birth weight up to 20%. Intercourse is generally discouraged when bed rest is recommended.

Monitoring a multiple pregnancy: Prenatal diagnosis by chorionic villus sampling can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities Amniocentesis is performed between 16 to 20 weeks. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation. Tocolytic agents are medications that may slow or stop premature labor. These medications are given in hospital “emergency” settings in an attempt to stop premature labor.

Cesarean section: Vaginal delivery of twins may be safe in some circumstances. Many twins can be delivered vaginally if the presenting infant is in the head first position. Most triplets will be delivered by Cesarean section. Appropriate anesthesia and neonatal support are essential, whether delivery is performed vaginally or requires Cesarean section.

For comments and archives

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

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

Whole blood

Definition: Whole blood contains 350 ml. of donor blood plus anticoagulants.

350 ml.

Between 2° C to 6° C in approved Blood Bank refrigerator

Shelf Life:
35 days


  1. Red cell replacement in acute blood loss with hypovolemia
  2. Exchange transfusion


  1. Chronic anemia
  2. Incipient cardiac failure

Dosage: One unit of whole blood increases Hemoglobin by 0.75 to 1 gm/dl and hematocrit by 3–5 %.


  • Must be ABO and RhD compatible with the recipient
  • Never add medications to the unit of blood
  • Complete transfusion within 4 hours of commencement

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The paradox of our time

The paradox of our time in history is that we have taller buildings, but shorter tempers; wider freeways, but narrower viewpoints. We spend more, but have less; we buy more, but enjoy it less. We have bigger houses and smaller families; more conveniences, but less time. We have more degrees but less sense; more knowledge, but less judgment; more experts, yet more problems; more medicine, but less wellness.

We drink too much, smoke too much, spend too recklessly, laugh too little, drive too fast, get too angry too quickly, stay up too late, get up too tired, read too little, watch TV too much, and pray too seldom. We have multiplied our possessions, but reduced our values. We talk too much, love too seldom and hate too often.

We’ve learned how to make a living, but not a life. We’ve added years to life, not life to years. We’ve been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor. We’ve conquered outer space, but not inner space. We’ve done larger things, but not better things. We’ve cleaned up the air, but polluted the soul. We’ve split the atom, but not our prejudice. We write more, but learn less. We plan more, but accomplish less. We’ve learned to rush, but not to wait. We build more computers to hold more information, to produce more copies than ever, but we communicate less and less.

These are the times of fast foods and slow digestion; big men, and small character; steep profits, and shallow relationships. These are days of two incomes, but more divorce; fancier houses, but broken homes. These are days of quick trips, disposable diapers, throwaway morality, one night stands, overweight bodies, and pills that do everything from cheer, to quiet, to kill. It is a time when there is much in the show window and nothing in the stockroom. A time when technology can bring this letter to you, and a time when you can choose either to share this insight, or to just hit delete.

Remember spend some time with your loved ones, because they are not going to be around forever. Remember to say a kind word to someone who looks up to you in awe, because that little person soon will grow up and leave your side. Remember to hold hands and cherish the moment for someday that person will not be there again. Give time to love, give time to speak, and give time to share the precious thoughts in your mind.

Always remember: Life is not measured by the number of breaths we take, but by the moments that take our breath away.

For comments and archives

  Cardiology eMedinewS

Radial PCI May Be Best Bet For ACS Patients Read More

Trauma Patients At Risk For Hypothermia Read More

  Pediatric eMedinewS

LEBER Congenital Amaurosis Type 18 Gene Identified Read More

Getting A Pet May Help Autistic Children Improve Their Social Skills, A Small Study Showed Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and also stop low dose aspirin.
Lesson: In dengue, low dose aspirin should be discontinued.

For comments and archives

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

For comments and archives

    Legal Question of the Day

(Dr MC Gupta)

Q. Should it be acceptable to the medical profession that after the MBBS degree is given to a student by a university, he should be denied registration by the medical council unless he passes an exit exam as proposed by the MCI? If he fails, that means he was not given proper education and the university, the medical college and the MCI failed in their duty to provide proper education. I think the punishment for failing to discharge their responsibility should fall on these entities and not on the medical students who stand to suffer by prolongation, in effect, of their 5–1/2 years’ course by maybe 6 months and deprivation from earning during this period and by general delay in their career prospects. What are your views?


  • Your concern is correct.
  • The objective of the exit test is to ensure minimum acceptable standards in a physician before he is licensed by the medical council. The university ought to have exactly the same objective—"to give such education and training as will be required for licensing by the medical council". If the MBBS course and degree granted by the university are themselves certified/recognised by the medical council, there should be no reason why the university, the college and the MCI should not work together towards the common aim of giving quality education.
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  Quote of the Day

(Dr GM Singh)

A good way to change someone's attitude is to change your own.
Because, the same sun that melts butter, also hardens clay!
Life is as we think, so think beautifully.

    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)


Lipase is an enzyme produced by the pancreas to help digest fats, proteins, and carbohydrates.

  • Very high levels: Acute pancreatitis.
  • High levels: Pancreatic duct obstruction, pancreatic cancer, and other pancreatic diseases.
  • Moderately increased levels: Kidney disease, salivary gland inflammation, a bowel obstruction, or peptic ulcer disease.
  • Low levels: May indicate permanent damage to the lipase–producing cells in the pancreas.
    Mind Teaser

Read this…………………

What is the best reason for the nurse in instructing the client to rotate injection sites for insulin?

A. Lipodystrophy can result and is extremely painful
B. Poor rotation technique can cause superficial hemorrhaging
C. Lipodystrophic areas can result, causing erratic insulin absorption rates from these
D. Injection sites can never be reused

Yesterday’s Mind Teaser: Included in the plan of care for the immediate post-gastroscopy period will be:

A. Maintain NGT to intermittent suction
B. Assess gag reflex prior to administration of fluids
C. Assess for pain and medicate as ordered
D. Measure abdominal girth every 4 hour

Answer for Yesterday’s  Mind Teaser: B. Assess gag reflex prior to administration of fluids

Correct answers received from: Raju Kuppusamy, Dr. Thakor Hitendrsinh G,Dr Jainendra Upadhyay,Dr.Chandresh Jardosh,Dr Avtar Krishan

Answer for 4th August Mind Teaser: C. Progressive weight gain
Correct answers received from:Dr. Thakor Hitendrsinh G,Dr Jainendra Upadhyay,Dr.Chandresh Jardosh,Dr Avtar Krishan

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)


K- kaisa
L- laga

    Medicolegal Update

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

Medical fasting

  • Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established
  • The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
  • Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
  • Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
  • In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

IYCNCON 2012 organized to defeat malnutrition

Malnutrition in children is a major concern in India & South Asia, said the experts in a joint stamen during IYCNCON 2012 being organized at IYCNCON 2012 by IYCF Chapter of IAP, Ministry of health and family welfare Govt. of India., Ministry of women and child development, WHO, UNICEF, IMLEA, SDHE Trust, IJCP and eMedinewS. The theme of the conference was “Proper Nutrition: Defeat Malnutrition – Investing in the Future”

The panelist included Dr. K.K. Aggarwal, Dr. R.K. Agarwal, Dr. A.P. Dubey, Dr. S. Aneja, Dr. M.M.A. Faridi, Dr. Satish Tiwari, Dr. Narender Yadav, Dr. Naresh Garg, Dr. Balraj Singh Yadav , Dr. Vishesh Kumar, Dr. Dheeraj Shah, Dr. Malobika, Dr. Praveen Kumar, Dr. Alka Kuthe, Dr. Sanjay Wazir, Dr. Padamjeet Gulia and Dr. Ashish Jain.

The experts said that out of nearly 115 million children below the age of five, in India, about 60 million are malnourished. Malnutrition impairs intelligence, strength, energy & productivity. It is also the major cause of mortality & morbidity Most of these deaths occurring in <5 years age group are attributed to the Malnutrition & India is a home to more than a third of world's undernourished children.

Reducing the infant & child mortality by 2/3rd by the end of year 2015 is one of the key components of the Millennium Development Goals (MDG) which have become the most widely accepted yardstick of development efforts by the Government, Donors & NGOs. Lack of nutritional health education & non-implementation of proper infant & young child feeding practices in Indian community/ society is the sole responsible factor for the gap between targeted goals & the achievements.

IYCNCON 2012 is aimed at achieving the optimal breastfeeding & Infant & Young Child Feeding Practices to fight with the malnutrition. IYCF guidelines prepared by IAP, WHO & UNICEF have been accepted as guidelines by the Govt. departments for dissemination/implementation all over India for the benefit of future generations of our country. Hon. Prime Minister Sh. Manmohan Singh has already accepted that the prevalence of Malnutrition in our country is “National shame”. The GOI has also proposed to start a “SWASTH BHARAT” campaign on TV & Radio.

    Readers Response
  1. Very nice and informative endeavour. Dr Varsha Gupta.
    Forthcoming Events
Dr K K Aggarwal

Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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