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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 (March 10-13); 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

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  Editorial …

7th May 2013, Tuesday

Deadly scrub typhus on the rise in Chennai;
do not ignore fever with black patch on the skin

There is a sudden spurt in the number of cases in Chennai with patients presenting with fever not responding to conventional antibiotics for three weeks and associated with brown mark in the skin. Scrub typhus spreads when chiggers - mites found in forests and, more recently, in urban shrubs - bite the person and inject a microorganism Rickettsia tsutsugamushi into the blood. The bite area turns black, the major symptom of the disease. The fatality rate is 8%. The disease shows symptoms similar to dengue, typhoid and malaria.

  1. Scrub typhus is a mite-borne infectious disease
  2. It is caused by Orientia tsutsugamushi (previously called R. tsutsugamushi).
  3. The reservoir and vector of scrub typhus are larval trombiculid mites of the genus Leptotrombidium.
  4. Scrub typhus may begin insidiously with headache, anorexia, and malaise, or start abruptly with chills and fever. As the illness evolves, most patients develop high fever, worsening of headache severity and myalgias. An eschar or rash may develop in a subset of patients. The severity of infection can range from mild symptoms and signs to multiorgan failure.
  5. Diagnostic include serology, biopsy, culture and polymerase chain reaction.
  6. The indirect fluorescent antibody (IFA) test remains the mainstay of serologic diagnosis; a 4-fold rise in titers over a 14-day period is conclusive.
  7. The differential diagnosis of scrub typhus includes malaria, dengue, leptospirosis and other rickettsial diseases.
  8. Doxycycline is the drug of choice.
  9. Scrub typhus may cause spontaneous abortions in pregnant women.
  10. Azithromycin is an alternative drug to treat scrub typhus in pregnancy.
  11. Several studies have demonstrated that chemoprophylaxis with a long-acting tetracycline is highly effective when used by nonimmune individuals living or working in areas in which scrub typhus is endemic.
  12. The use of insect repellants and miticides are highly effective when applied to both clothing and skin.
  13. Permethrin and benzyl benzoate are also useful agents when applied to clothing and bedding.

For Comments and archives…

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

Vowel chanting produces aspirin in my body

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    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2013

Heart Care Foundation of India and World Fellowship of Religions in association with Ministry of Earth Sciences Govt. of India and Delhi Public School Mathura Road observed World Earth Day 2013.

Dr K K Aggarwal
    National News

At 100, a woman undergoes dialysis in Chhattisgarh

RAIPUR: The Pt Jawahar Lal Nehru hospital, Raipur claims to have created a record of sorts by successfully conducting dialysis on a 100 year old woman. Claimed to be the first such case in the country and perhaps one the very few in the world, the woman, who hails from Ambikapur region, is reportedly responding well to the post dialysis treatment and is likely to be discharged soon. Talking to TOI, Dr Puneet Gupta, a senior Nephrologists, the woman, whose identity is not being disclosed in order to protect the family's privacy, was admitted to the hospital a week ago in an unconscious state. "Her condition was precarious as her urine output was low and tests conducted on her revealed that she was suffering from a renal failure and was anaemic", the doctor said. Dr Gupta said that since dialysis was the only option and her advanced age was a matter of deep concern, the choice of going into the procedure was left to the family. "We apprised them of all the possibilities and they agreed for the procedure", he said adding that the world over very few people in such advance ages opt for it. He said the procedure was conducted on her and her condition is now stable. He said she would be discharged after a couple of days and was presently being kept under observation. Dr Gupta said post-dialysis, he searched the internet extensively to learn if any such cases existed in the world. "I'm sure that there are none in India and my research on the internet reveals that two cases of similar nature have been done in Israel and London", he added. Dr Gupta may not be too wrong as various articles on the internet do suggest that dialysis in such advanced aged are rare, as most patients prefer to die peacefully under medical care rather than undergoing the procedure. Talking about the survival rate, Dr Gupta said for dialysis at the age of 65-70, it is 24.9 months and goes lower to 8.4 months if the patient is above 90 years. (Source: TOI, May 6, 2013)

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, every Thursday 4:30 PM in DD India

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Working definition of child abuse

Physical abuse is inflicting physical injury upon a child. This may include hitting, shaking, kicking, beating, or otherwise harming a child physically.

    Valvular Heart Disease Update

What is very severe aortic stenosis?

Very severe AS is defined as an aortic valve area of =0.75 cm2 (critical AS) accompanied by a peak aortic jet velocity = 4.5 m/sec or a mean transaortic pressure gradient =50 mmHg.

(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)

DKA improves with isotonic fluid protocol

Rates of death and disability were much lower among children with diabetic ketoacidosis when they were treated with a consistent protocol that supplied high levels of sodium, a researcher said during a poster session at the annual meeting of the Pediatric Endocrine Society. (Source: Medpage Today)

Prospect for parathyroid hormone replacement inches closer

Recombinant human parathyroid hormone given subcutaneously improved mineral homeostasis and was well tolerated in a 24-week phase 3 clinical trial of 134 adult patients with hypoparathyroidism. (Source: Medscape)

Young adults struggle with diabetes care

Adolescents with type 1 diabetes on the cusp of adulthood are at high risk for psychosocial distress and depression, which can adversely influence their growing need for self-care, a researcher said in a poster session at the annual meeting of the Pediatric Endocrine Society. (Source: Medpage Today)

HPV vaccine: 2 doses as good as 3 doses in young women

Young women who received 2 doses of human papillomavirus (HPV) vaccine had immune responses to HPV-16 and HPV-18 that were noninferior to those of young women who received 3 doses of the vaccine, according to a new study that included 830 girls and young women in Canada. (Source: Medscape)

Glucose variance tied to hypoglycemia risk

Greater variability in fasting blood glucose may pose a greater risk of hypoglycemia for type 1 and type 2 diabetics, researchers reported here at the American Association of Clinical Endocrinologists meeting. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Low cholesterol linked to anxiety, depression, suicide, hemorrhagic stroke and cancers People with very low... http://fb.me/25oniXXkN

@DrKKAggarwal: How do you keep your creativity alive as you progress further into adulthood? http://tinyurl.com/cewr5w5 #TheRabbitHole

    Spiritual Update

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

Is the time and place of death pre-defined?

Some gurus teach that the time and place of death is predefined and some do not. I personally feel that the life and respirations are predefined and not day and time of death.

For Comments and archives…

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

What are chocolate cysts?

Endometriosis may grow on the surface of the ovary as implants or invade inside the ovary and develop a blood–filled cyst called an endometrioma, or a "chocolate cyst." Chocolate cysts are so named because over time the blood they contain darkens to a deep reddish brown color. These cysts may be as small as a pea or grow to be larger than a grapefruit.

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

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

Blood warmers

Patients who receive refrigerated blood at rates faster than 100 mL/minute for 30 minutes have an increased incidence of cardiac arrest as compared with a control group receiving blood warmed to 37°C. Rapid infusion of large volumes of cold blood can lower the temperature of the sinoatrial node to below 30°C, at which point ventricular arrhythmias occur. Transfusions at such rapid rates generally occur only in the operating room or trauma settings. There is no evidence that patients receiving 1 to 3 units of blood over several hours have a comparable risk of arrhythmias; therefore, routine warming of blood is not recommended.

Several types of blood warmers are available: thermostatically controlled water baths; dry heat devices with electric warming plates and high–volume countercurrent heat exchangers with water jackets. Warming devices must not raise the temperature of blood above 42°C. Devices should have a visible thermometer and, ideally an audible alarm that sounds before the 42°C limit is exceeded. It is helpful for the standard operating procedure for warming blood to include guidelines on performing temperature and alarm checks, and instructions on what action to take when warmers are out of range.

Conventional microwave ovens and microwave devices for thawing plasma are not designed for warming blood and can damage red cells.

    An Inspirational Story

The blind boy!

A blind boy sat on the steps of a building with a hat by his feet. He held up a sign which said: “I am blind, please help.” There were only a few coins in the hat.

A man was walking by. He took a few coins from his pocket and dropped them into the hat. He then took the sign, turned it around, and wrote some words. He put the sign back so that everyone who walked by would see the new words.

Soon the hat began to fill up. A lot more people were giving money to the blind boy. That afternoon the man who had changed the sign came to see how things were. The boy recognized his footsteps and asked, “Were you the one who changed my sign this morning? What did you write?”

The man said, “I only wrote the truth. I said what you said but in a different way.” What he had written was: “Today is a beautiful day and I cannot see it.” Do you think the first sign and the second sign were saying the same thing?

Of course both signs told people the boy was blind. But the first sign simply said the boy was blind. The second sign told people they were so lucky that they were not blind. Should we be surprised that the second sign was more effective?

Moral of the story: Be thankful for what you have. Be creative. Be innovative. Think differently and positively.

Invite others towards good with wisdom. Live life with no excuse and love with no regrets. When life gives you a 100 reasons to cry, show life that you have 1000 reasons to smile. Face your past without regret. Handle your present with confidence. Prepare for the future without fear. Keep the faith and drop the fear.

Great men say, “Life has to be an incessant process of repair and reconstruction, of discarding evil and developing goodness…. In the journey of life, if you want to travel without fear, you must have the ticket of a good conscience.”

The most beautiful thing is to see a person smiling… And even more beautiful is knowing that you are the reason behind it!!!

For comments and archives

   Cardiology eMedinewS

Diet, 'anti-aging' supplements may help reverse blood vessel abnormality Read More

   Pedia News

New guide for electrophysiology training in Peds Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What is the importance of pre-exposure vaccination?

Pre-exposure vaccination simplifies post-exposure vaccination because after bite, those who have received full pre-exposure vaccination require only two doses of vaccine at Days 0 & 3. RIG is not required (WHO 2007).

    IJCP Special

Dr Good Dr Bad

Situation: A female with rheumatoid arthritis became pregnant while taking leflunomide.
Dr. Bad: You can continue to take it.
Dr. Good: Stop it immediately.
Lesson: In women with rheumatoid arthritis who become pregnant while taking leflunomide, healthy pregnancy outcomes usually occur, if the drug is discontinued at the earliest and a cholestyramine drug elimination procedure is done (Arthritis Rheum 2010;62:1494)

Make Sure

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue

  Quote of the Day (Dr GM Singh)

A dreamer is one who can only find his way by moonlight, and his punishment is that he sees the dawn before the rest of the world. Oscar Wilde

    Mind Teaser

Read this…………………

A female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this disorder increases the client’s risk of:

a. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
b. A decreased serum phosphate level secondary to kidney failure.
c. An increased serum calcium level secondary to kidney failure.
d. Metabolic alkalosis secondary to retention of hydrogen ions.

Yesterday’s Mind Teaser: A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing post procedure care, the nurse should:

a. Keep the client’s knee on the affected side bent for 6 hours.
b. Apply pressure to the puncture site for 30 minutes.
c. Check the client’s pedal pulses frequently.
d. Remove the dressing on the puncture site after vital signs stabilize.

Answer for Yesterday’s Mind Teaser: c. Check the client’s pedal pulses frequently.

Correct answers received from: Dr Ajay Mehta, Muthumperumal Thirumalpillai, DR ARPAN GANDHI, Dr.K.V.Sarma, Dr. B.B. Gupta, Dr. P. C. Das & Dr. Mrs. S. Das, DR AYYAVOO, drjella, Dr.Raghavendra Jayesh, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr. Thakor Hitendrsinh G,

Answer for 5th May Mind Teaser: b. 30 minutes

Correct answers received from: Dr Avtar Krishan, Dr. Thakor Hitendrsinh G,

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

A newly married husband saved his wife’s mobile number on his mobile as "My life".
After one year of marriage he changed the number to "My Wife".
After 2 years of marriage he changed the number to "Home"
After 5 years of marriage he changed the number to "Hitler".
After 10 years of marriage he changed the number to "Wrong Number".

  Medicolegal Update

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

Difference between antemortem and postmortem bruises

  • Some people bruise easily, whereas others may have tougher skin tissue. Apply a cold compress to the bruise for at least 10 minutes to reduce swelling or the amount of bruising after an injury,
  • In some cases of brought dead or dead on arrival, the doctor attending the case in emergency may be confused or is not be able to differentiate between antemortem bruise and postmortem artifact and the postmortem bruise is recorded in MLC report as injuries. I have seen such cases in AIIMS during autopsy.
  • Close examination by doctor in emergency may help to differentiate because in antemortem bruises there is swelling and damage to epithelium, coagulation and infiltration of the tissues blood and color changes. These signs are always absent in postmortem bruises.
  • It is seen that contusions and abrasions produced immediately after death show a very low degree of changes.
  • Appreciable bruising does not occur after 2–3 minutes of death due to arrest of heart and blood circulation, but by using great violence small bruises can be produced up to 3 hours after death where the tissue can be forcibly compressed against the bone or if the body is dropped on the ground from a height or from transport trolleys or running vehicle.
  • Some of the evidences of bleeding are seen without history of trauma due to tearing of small veins in the skin when the body is lifted from the scene of death and transportation handling and the same is called postmortem artifact.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Suspecting stroke and heart attack risk without tests

Carotid bruit, an unusual, harsh sound a doctor heard when passing a stethoscope over the main artery to the brain could indicate an increased risk of heart attack and death from heart disease and stroke, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

The sound is caused by turbulent blood flow due to buildup of fatty deposits in one of the two arteries that carry blood to the front and middle part of the brain. It is usually regarded as a possible indicator of increased risk of stroke.

An analysis of 22 studies involving more than 17,000 patients and published in The Lancet found that people with carotid bruits were more than twice as likely to have heart attacks or to die of cardiovascular disease. However patients who do not have carotid bruit may have other evidence of cardiovascular disease.

Physicians should routinely listen for possible carotid bruits when doing a physical examination of people who are middle–aged or older.

Studies have shown that there is a link between the risk of stroke and of coronary heart disease.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 47982 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

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