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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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  Editorial …

6th October 2011, Thursday

Superbug again in the news

Ganga Ram Hospital in Delhi has shown high prevelance of antibiotic–resistant superbug New Delhi Metallo–beta–lactamase 1 (NDM1). In ICU & wards the prevalence of NDM1 varied between 8.1% in E coli and 38.02% in K pneumoniae bacteria.

Dr C Wattal, Chairman, department of microbiology said the five month long study included 10,889 samples of which 2,669 from wards and 2,598 from ICU were found positive for bacteria. From these positive samples, they isolated 379 units of E coli and 305 isolates of K pneumoniae.

1. The Lancet in August 2010 first published a multi–centre study warning about NDM1.
2. Another study was published in the same journal about NDM1 superbug in seepage and tap water in Delhi.

1. NDM1 makes the bacteria highly resistant to almost all antibiotics, including carbapanems.
2. You can have drug sensitive bacteria; drug resistant bacteria; multi drug resistant bacteria and super bug (resistant to all conventional antibiotics).

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Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Superbug again in the news

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    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela to focus on potbelly obesity

Releasing a health message at press conference Padmashri & Dr. B.C. Roy National Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela and Dr A. K. Walia, Minister of Health, Government of NCT Delhi. In the Photo: Dr N K Yadav, MHO, MCD;Sh Praveen Aggarwal, General Manager, Coca Cola Ltd; Dr K S Baghotia, CMO, DHS.;

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


IGNOU sets up country’s first sign language training centre

The Indira Gandhi National Open University (IGNOU) will inaugurate the Indian Sign Language Research and Training Center (ISLRTC) on Tuesday at its main campus in the capital. The centre has been set up with the help of the Ministry of Social Justice and Empowerment. "The centre is the realisation of a long–cherished dream of the hearing impaired community in India. It is an exclusive education project for teaching, learning, training and capacity building for the vast deaf population. It will be a full time teaching and training centre for the Indian sign language combined with distance teaching/ learning opportunities," said Prof VN Rajasekharan Pillai, VC, IGNOU."This research centre is the first of its kind in India with centres attached to IGNOU," said Prof. PR Ramanujam, Pro VC, of IGNOU before adding that research and documentation will back up the intensive training being imparted at the centres. (Source: The Pioneer, 04 October 2011)

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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

(Dr Monica and Brahm Vasudev)

Nobel Physics Prize honours ‘Expanding Universe’ find

Saul Perlmutter, Brian P. Schmidt and Adam G. Riess won the Nobel Prize in physics on Tuesday for their studies of exploding stars that revealed that the expansion of the universe is accelerating.

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Thin parents produce kids with less body fat

Children whose parents are thin are thrice as likely to be lean than those with overweight parents, new research says. The study by University College London (UCL) is based on results from the Health Survey for England, in which data is collected annually from multiple households. From 2001 to 2006, trained interviewers recorded the height and weight of parents and up to two children in 7,000 families. They used this information to calculate their Body Mass Index (BMI), a height to weight ratio, reports the journal Archives of Paediatrics & Adolescent Medicine. (Source: TOI, Oct 4, 2011)

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Parents often shun recommended childhood vaccine schedule

An artificially low perceived risk for vaccine–preventable diseases, combined with an artificially high perceived risk for side effects potentially associated with vaccines, causes many parents to shun the recommended schedule for childhood vaccinations and adopt alternative schedules, according to the lead author of a report published online October 3 in Pediatrics. (Source: Medscape Medical News)

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    Twitter of the Day

@DrKKAggarwal: The sapling that bends is stronger than an oak tree.

@DeepakChopra: CosmicConsciousness Think cosmically, communicate globally, act locally but with global and cosmic impact.

    Spiritual Update

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

Science behind 7th Navratri or Kalratri Mata Worship

Navratri is the detoxification of body, mind and soul. Body detoxification involves Navratri diet containing eating less devoid of cereals. In Navratri diet, flour is replaced with Kuttu or Singhara flour; pulses with amaranth or Rajgiri and Rice with Samak rice

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    An Inspirational Story

(Dr Anil Kumar Jain)

At a time when the Dark Ages were looming large, the existence of a university of Taxila’s grandeur really makes India stand apart way ahead of the European countries who struggled with ignorance and total information blackout. For the Indian subcontinent Taxila stood as a light house of higher knowledge and pride of India. In the present day world, Taxila is situated in Pakistan at a place called Rawalpindi. The university accommodated more than 10,000 students at a time. The university offered courses spanning a period of more than eight years. The students were admitted after graduating from their own countries. Aspiring students opted for elective subjects going for in depth studies in specialized branches of learning. After graduating from the university, the students are recognized as the best scholars in the subcontinent. It became a cultural heritage as time passed. Taxila was the junction where people of different origins mingled with each other and exchanged knowledge of their countries.

The university was famous as "Taxila" university, named after the city where it was situated. The king and rich people of the region used to donate lavishly for the development of the university. In the religious scriptures also, Taxila is mentioned as the place where the king of snakes, Vasuki selected Taxila for the dissemination of knowledge on earth.

Here it would be essential to mention briefly the range of subjects taught in the university of Taxila. (1) Science, (2) Philosophy, (3) Ayurveda, (4) Grammar of various languages, (5) Mathematics, (6) Economics, (7) Astrology, (8) Geography, (9) Astronomy, (10) Surgical science, (11) Agricultural sciences, (12) Archery and Ancient and Modern Sciences.

The university also used to conduct researches on various subjects. Taxila. So prominent was the place where Chanakya received his education that it goes to show the making of the genius. The very requirements of admission filtered out the outlawed and people with lesser credentials.

Kautilya and Vishnugupta, the names by which the ancient Indian political treatise called the "Arthashastra" identifies its author, are traditionally identified with Chanakya. The Kautilya Arthasastra, a Sanskrit work of the 4th century B.C., is more known for its contents on politics and statecraft. But the book contains information and instructions about various other aspects of social life, including man’s relationship with animals and plants. Where are those days of Indian grandeur and pride? We have to do something, something extraordinary. I strongly believe that we can do it in near future. Nation is expecting it from our younger generation.

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

October is National Breast Cancer Awareness Month

Teresa Heinz, the wife of 2004 Democratic presidential nominee Sen. John Kerry, disclosed today that she is battling breast cancer in an editorial in the Pittsburgh Post–Gazette. "I was diagnosed and treated for stage one cancer (two different types) in both breasts. The cancer was detected at an early stage thanks to a mammogram and the work of a remarkable physician who insisted on investigating beyond what the mammogram could show," she writes, "I have had two operations and my prognosis for a full recovery is good." Heinz editorializes that women should ignore new guidelines from the U.S. Preventive Services Task Force that stated women at average risk don’t need regular screenings and that mammograms in older women can be reduced to every two years, versus previous annual guidelines.

She opines that the task force is "predisposed to choose numbers over people." "Our busy lives are full of those. What we need are more reasons to keep those appointments, more support of the value of prevention and refinement of diagnostic procedures, and more choices." The Obama administration has distanced itself from the task force’s recommendations amid backlash from women’s and medical groups. The Department of Health and Human Services did not endorse the findings.

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    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Can an MBBS call himself as a physician?


1. The MCI Ethics Regulations, 2002, refer to the word ‘physician’ more than a 100 times. A reading of the regulations shows that the word physician is used as a synonym for Registered Medical Practitioner by the MCI with the difference that a person may be a physician but not an RMP. Such a situation may arise when a person is enrolled on the state medical register but not on the IMR.

2. If I am an MBBS but I practice only medicine and choose not to do any surgery, there is nothing wrong if I hold out as a physician alone and not as a surgeon. Thus there would be nothing wrong if a person displays his credentials as follows in his clinic / letterhead etc.:
"Dr. ABC
MBBS (Registration no. …….., …. Medical Council)

For comments and archives

    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What is the need for microscopic diagnosis?

Microscopy of air–dried and stained thick and thin smears of capillary blood remains the gold standard method for confirming the diagnosis of malaria. Techniques for preparing, staining and examining blood smears described in many texts, varies with the type of stains used. The advantages of microscopy are that its sensitivity is high; it is possible to detect a parasite density as low as 10 per μl; it is possible to distinguish the four species of human malaria parasite (among which P. falciparum, P. vivax and P. malariae occur in India) and different parasite stages, which may be present in peripheral blood and it costs very less.

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    Medicine Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

What is the treatment of Wilson’s disease?

Pharmacological therapy: Initial treatment for symptomatic patients should include a chelating agent (D–penicillamine or trientine). Trientine may be better tolerated.

  • Penicillamine: It is a general chelator and induces cupruria. Maximum dose is 20 mg/kg/day. Side effects are Fever, rash, proteinuria, lupus–like reaction, aplastic anemia, leukopenia, thrombocytopenia, nephrotic syndrome, degenerative changes in skin, elastosis perforans serpingosa, serous retinitis and hepatotoxicity.
  • Trientine: It is a general chelator and induces cupruria. Maximum dose is 20 mg/kg/day. Side effects are gastritis, aplastic anemia and sideroblastic anemia.
  • Zinc: It is a Metallothionein inducer and blocks intestinal absorption of copper. Usual dose in adults is 50 mg elemental zinc thrice–daily. Side effects are gastritis and biochemical pancreatitis.
  • Tetrathiomolybdate: It is a chelator which blocks copper absorption. Side effects are anemia, neutropenia, and hepatotoxicity.

Dietary: Patients should avoid intake of foods and water with high concentrations of copper, especially during the first year of treatment. Treatment of presymptomatic patients: This can be accomplished with a chelating agent or with zinc. Trientine may be better tolerated.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Uric acid

  • To rule out gout
  • To monitor uric acid levels when undergoing chemotherapy or radiation treatment.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with severe migraine wanted to know if xylocaine drops would help.
Dr. Bad: They have no role.
Dr. Good: You can try them.
Lesson: 2% xylocaine drops, as an intranasal spray, can help migraine patients.

For comments and archives

Make Sure

Situation: A patient on binasal oxygen developed nasal mucosal damage.
Reaction: Oh my God! Why was the oxygen given at the rate of 4 liters per minute?
Lesson: Make sure that oxygen via nasal catheter is not given at a rate of >3 liters per minute.

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  Quote of the Day

(Dr GM Singh)

A plant blooms daily after shedding the flowers of yesterday, so let our happiness bloom daily shedding the sorrows of yesterday.


New kid on the block: Someone new to the group or area

  Sri Chanukah Niti–Sastra: The Political Ethics of Chanakya Pandit

(Dr Anupam Sethi Malhotra)

Women have hunger two–fold, shyness four–fold, daring six–fold, and lust eight–fold as compared to men

    Medicolegal Update

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

What is a Grievous Hurt–Indian Penal Code?

It is very difficult to draw a line between those bodily hurts which are serious and those which are slight. To make out the offence of voluntarily causing grievous hurt, there must be some specific hurt, voluntarily inflicted and coming within the scope of following as per law. According to Indian Penal Code Section 320, the following kinds of hurt are designated as "grievous".

  1. Emasculation: It means depriving a male of masculine power.
  2. Permanent privation of sight of either eye: The gravity lies in the permanency because it deprives a person the use of the organ of sight.
  3. Permanent privation of the hearing of either ear: It deprives a man of his sense of hearing. Injury to the tympanum or auditory nerve or by thrusting something into the ear which causes deafness.
  4. Privation of any member or joint: The term ‘member’ means an organ or a limb being part of man capable of performing a distinct function. It includes, nose, mouth, hands, feet, phalanges etc.
  5. Destruction or permanent impairing of the powers of any member or joint: the use of limbs and joints of body are essential to the discharge of the normal functions of the body. Their deprivation causes lifelong crippling and makes the person defenseless and miserable.
  6. Permanent disfiguration of the head or face: The word ‘disfigure’ means to cause some external injuries which detracts from personal appearance but does not weaken a person.
  7. Fracture or dislocation of a bone or tooth: It is not necessary that a bone should be cut through and through; cut should be up to the medulla. If there is a break by cutting or splintering of the bone or there is a rupture or fissure in it, it would amount to a fracture but the doctor must document the dimension of fracture and duration/age correlation with age of injury. Dislocation means displacement. Mere looseness of teeth will not amount to dislocation. It has to prove that the tooth was originally not loose and that there was fracture or dislocation by the injury.
  8. Any hurt which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days: A wound may cause intense pain, prolonged disease or long lasting body injury but does not fall under any of the seven clauses. A body injury/beating may not mutilate the sufferer or fracture his bones but may be so harsh and painful may cause even death. The eighth clause provides for such hurts. This includes three different types of hurt.

These are:

  • Any hurt which endangers life
  • Any hurt which causes the victim to be in severe bodily pain for a period of 20 days
  • Any hurt which prevents the victim from following his ordinary pursuits for a period of 20 days

For comments and archives

    Mind Teaser

Read this…………………

All of the following statements regarding local treatment of early stage breast cancer are correct except?

1. Mastectomy is the surgery of choice for multi–centric breast cancer.
2. Post–mastectomy chest wall irradiation in women with large tumor size or multiple involved lymph nodes reduces the risk of recurrence.
3. Previous radiation therapy to the breast is not a contraindication to breast conservative approach.
4. Sentinel lymph node biopsy is an alternative to axillary node dissection in women with a clinically negative axilla.

Yesterday’s Mind Teaser: Which is correct to say, "The yolk of the egg are white" or "The yolk of the egg is white"?

Answer for Yesterday’s Mind Teaser: Neither, the yolk of the egg is yellow

Correct answers received from: Dr Prabha Sanghi, Dr Shirish Singhal, Rakesh Bhasin, Dr Rajshree Aggarwal, Dr HL Kapoor, Dr Chandresh Jardosh, Dr Anil Kumar Jain, Dr K Raju, Muthumperumal Thirumalpillai, Dr Mayur Gunderia, Dr Bharat Bhushan Aggarwal, Neelam Nath, Anil Bairaria, Dr Bharat Bhushan Aggarwal.

Answer for 4th October Mind Teaser
: a. HPV–related warts may become more prominent in patient on highly active antiretroviral therapy secondary to immune reconstitution.
Correct answers received from: Dr Bharat Bhushan Aggarwal, Dr Anil Kumar Jain, Renu Garg.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Veena Aggarwal)

Murphy’s Laws for Humor

You can never determine which side of the bread to butter. If it falls down, it will always land on the buttered side.

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

MTNL Perfect Health Mela to focus on potbelly obesity

In the forthcoming Perfect Health Mela, Heart Care Foundation of India will provide free metabolic profile including blood tests and clinical examinations for people with potbelly obesity.

Addressing a press conference here, Padmashri & Dr. B.C. Roy National Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela said that India is running an epidemic of metabolic syndrome which is characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high sugar. Abdominal girth of more than 90 cm in men and 80 cm in women indicates that the person is suffering from proneness to future heart attack.

Releasing a health message, Dr A. K. Walia, Minister of Health, Government of NCT Delhi said that Delhi has already launched a diabetes and cardiovascular prevention programme. Dr. Walia said that it is a sad state of affairs that more than 12% people have high blood pressure and around 10% have diabetes.

Dr. Walia released the message, "Diabetes and high blood pressure are silent killers – Detect them early and keep them under control".

Dr. Walia further said that people should live a controlled lifestyle so that diabetes can be prevented.

Co-addressing the press conference Senior Representatives from MCD, NDMC, MTNL, LIC, SAIL, DST and Coca Cola India Ltd. in a joint statement said that an ounce of prevention is better than a kg of treatment.

Giving further details about the Mela, Dr. Aggarwal said that this year the mela will be multi-locational. A daylong conference on effect of climatic change on women health is being organised at YWCA. For the first time, doctors from all pathies will meet under one roof on Sunday, 16th October, 2011 at Acharya Sushil Muni Ashram, Defence Colony to charter a consensus on lifestyle incorporating all pathies.

Cultural Shows are being planned including Dandiya Show with Mr. Shanker Sawhney on Sunday, 16th October at Garden of Five Senses; Drum Jam Show at Ansal Plaza on Monday, 17th October at 7pm,; Kavi Sammellan with Mr. Ashok Chakradhar and lively cultural evening with Sukhmani at Siri Fort Auditorium on 18th. From 19th to 23rd October, the traditional mela will shift to Laxmibai Nagar, NDMC Grounds where the fair will be a mix of exhibition, competitions, checkups and infotainment.

There will be over 4000 school children, 2000 nurses, 1000 medical students and youth participating in various competitions at the mela venue. The entry to the mela and all these activities will be free.

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    Readers Responses
  1. Dear Dr Aggarwal,Congratulations!! What I liked most was a section on common public health related concerns and issues. I really love this daily dose and would also like to contribute for promoting evidence based practices in the Reproductive Health including family planning. Dr Dinesh Agarwal, Senior Programme Officer, RH UNFPA, India
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals

Dr K K Aggarwal

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    Our Contributors

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