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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 …

7th September 2011, Wednesday

Dengue Special

Transfusion–related acute lung injury (TRALI)

Transfusion of even one unit of a plasma–containing blood product sometimes causes acute lung injury/acute respiratory distress syndrome (ALI/ARDS).(1,2)

What can cause TRALI: Fresh frozen plasma, platelet, and packed red blood cell transfusions?

Definition: New ALI occurring during or within 6 hours after a transfusion.

Pathogenesis: A "two–event" hypothesis holds that recipient granulocytes are primed, either by transfused active substances or by virtue of the patient’s underlying clinical condition. Preformed anti–leukocyte antibodies contained in the transfusion product then "activate" these functionally hyperactive granulocytes.

Which donors: Anti–leukocyte antibodies are more likely to be found in blood donated by multiparous women due to sensitization to fetal antigens during pregnancy.

When to suspect: Whenever dyspnea, hypoxemia, and pulmonary infiltrates occur during or within 6 hours after transfusion of any plasma–containing blood product.

Differential diagnosis

  • Transfusion–associated circulatory overload
  • Hemolytic transfusion reaction
  • Anaphylaxis of IgA–containing products to a IgA deficiency recipient

Management: Supportive (mechanical ventilation, supplemental oxygen, diuretics when volume overload is present). Clinical improvement will occur spontaneously as lung injury resolves.

Action: Individuals who have developed TRALI should receive no further plasma–containing blood products from the implicated donor.


  • Take plasma products only from male donors
  • Screen previously–pregnant and previously–transfused apheresis donors for HLA antibodies
  • Start testing for the detection of white blood cell antibodies


  1. Bux J, Sachs UJ. The pathogenesis of transfusion–related acute lung injury (TRALI). Br J Haematol 2007;136:788.
  2. Khan H, Belsher J, Yilmaz M, et al. Fresh–frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007;131:1308.

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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

Dengue Special

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Harmony – An Inter School Health Festival at Perfect Health Mela 2010

Students from various schools took active part in the drawing competiton in the Harmony – An Inter School Health Festival at Perfect Health Mela 2010

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


WHO–FIP initiative to involve pharmacists in combating TB

HYDERABAD: In a major initiative to combat TB epidemic, the World Health Organisation and the International Pharmaceutical Federation (FIP) signed a joint statement here on Sunday seeking to involve pharmacists in tuberculosis care and control. The statement was signed by Hiroki Nakatani, WHO Assistant Director–General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases and FIP president, Michel Buchmann, at the World Congress of Pharmacy and Pharmaceutical Sciences 2011 and the 71st International Congress of FIP. The event was inaugurated by President Pratibha Patil earlier. Dr. Nakatani said that TB was one of the major killers worldwide claiming five million lives per year. Referring to the emergence of multi–drug resistant TB due to underuse, overuse and misuse of anti–TB drugs, he pointed out that India was home to largest burden of TB patients and emphasised the importance of collaboration with pharmacists.

(Source:http://www.thehindu.com/news/states/andhra–pradesh/article2425962.ece,September5, 2011)

For Comments and archives

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)

Remote monitoring of ICDs may be ready for prime time

It seems that remote monitoring of implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices has been "promising" for some time. But three randomized trials and several smaller studies presented at the European Society of Cardiology meeting here could bring telemonitoring closer to routine practice. Two of the randomized trials – EVATEL and ECOST – showed that remote monitoring reduced inappropriate shocks and anti–tachycardia pacing, and also decreased the risk of shock–related hospitalization. Interestingly, ECOST also found that the reduction in inappropriate therapy had a positive impact on battery longevity. The third randomized trial – TRUST ICD – found that remote monitoring reduced the number of "non–actionable in–hospital evaluations." Researchers defined "actionability" as changes in programming, antiarrhythmic drugs, or system components. (Source: Medpage Today)

For comments and archives

Menopause role in heart risk disputed

Heart disease mortality in women increased with age but menopause did not appear to play a role, a 50–year review of mortality trends showed, disputing the belief that premenopausal hormones protect women from heart disease, investigators said. No spike in heart disease mortality occurred at menopausal ages in women from three large birth cohorts from the U.S., England, and Wales. Instead, mortality increased steadily across all age groups of adult women. In contrast, men had an accelerated risk of dying of heart disease at younger adult ages, but mortality plateaued at middle and older ages, as reported online in BMJ. (Source: Medpage Today)

For comments and archives

Gene defect that may cause leukaemia discovered

Scientists have discovered a new genetic mutation which they say could identify people who are susceptible to acute myeloid leukaemia, a type of blood cancer that kills thousands every year. An international team of researchers found mutations in a gene, called GATA2, which among other roles, controls the process that changes primitive blood-forming cells into white blood cells. The findings, published in the journal Nature Genetics, could lead to a genetic test allowing people with a family history of leukaemia to find out if they carry the faulty gene before their symptoms emerge, the researchers said.

(Source: http://www.thehindu.com/health/medicine–and–research/article2427138.ece)

For comments and archives

    Fitness Update

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

Laughter has positive impact on vascular function

Watching a funny movie or sitcom that produces laughter has a positive effect on vascular function and is opposite to that observed after watching a movie that causes mental stress according to research conducted at the University of Maryland School of Medicine in Baltimore, Maryland. "The idea to study positive emotions, such as laughter came about after studies had shown that mental stress caused blood vessels to constrict," says Dr. Michael Miller, Professor of Medicine and lead investigator.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: You cannot make your future perfect if you carry the past to the future; instead learn a lesson from it. – Ladylynice

@DeepakChopra: Objectivity enables you to view any person or situation with compassion.

    Dr KK Answers

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

What is the exposure in a cardiac cath and EP study?

A typical X–ray procedure results in a total effective dose of 8.3 mSv per hour of fluoroscopy. The mean cardiac fluoroscopy time in managing paroxysmal atrial fibrillation is 57 minutes, atrial flutter is 20 minutes, ablation is 22 minutes and pulmonary vein isolation is 39 minutes.

For comments and archives

    Spiritual Update

Am I 53 or 18 years old with 35 years of experience

I was born on 5th September, Friday, 1958. It being a Janmashtami day, I was named Krishan Kumar by my parents.

Whenever my birthday comes I start wondering why do we call ourselves as old (53–years–old in my case) and why do we blow off the candles on that day. I personally feel blowing off the candles is not the right thing as per our mythology. Producing darkness is not what our Vedas teach us. Instead we should light the candle and not blow it off.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Cure for Sorrow

There is an old Chinese tale about a woman whose only son died. In her grief, she went to the holy man and said, "What prayers, what magical incantations do you have to bring my son back to life?"

Instead of sending her away or reasoning with her, he said to her, "Fetch me a mustard seed from a home that has never known sorrow. We will use it to drive the sorrow out of your life." The woman went off at once in search of that magical mustard seed.

She came first to a splendid mansion, knocked at the door, and said, "I am looking for a home that has never known sorrow. Is this a place? It is very important to me."

They told her, "You’ve certainly come to the wrong place," and began to describe all the tragic things that recently had befallen them.

The woman said to herself, "Who is better able to help these poor, unfortunate people that I, who have had misfortune of my own?" She stayed to comfort them, then went on in search of a home that had never known sorrow. But wherever she turned, in hovels and in other places, she found one tale after another of sadness and misfortune. She became so involved in ministering to other people’s grief that ultimately she forgot about her quest for the magical mustard seed, never realizing that it had, in fact, driven the sorrow out of her life.

For comments and archives

    Gastro Update

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

What lab tests help in the diagnosis of IBD?

  • Complete blood count (FBC), C–reactive protein (CRP), erythrocyte sedimentation rate (ESR), and liver function tests (LFTs) (especially albumin). Reduced levels of hemoglobin, raised inflammatory markers (CRP, ESR, and platelets), and reduced serum albumin are suggestive of IBD.
  • Stool cultures should be carried out to exclude infectious diarrhea and stool tested for Clostridium difficile toxins A and B prior to invasive tests. Identification of the pathogen, however, does not necessarily exclude a diagnosis of IBD because a first episode of IBD may present after documented enteric infection.
  • In children from populations at risk for tuberculosis (TB), this should be excluded.
  • The noninvasive stool tests of fecal calprotectin and lactoferrin may become increasingly important both for screening and monitoring disease activity to avoid more invasive investigations.
  • Abdominal radiography is essential for assessment of patients with suspected severe colitis to exclude colonic dilatation and silent perforation.

For comments and archives

  Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist, Max Hospital)

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

Day – 1 Interesting Highlights

Session 1 – Foundations of Infertility Management

This session will focus on the basics of infertility diagnosis without which successful treatment is not possible. This will also highlight which patients will benefit from IVF treatment sooner rather than later.

Speakers: Dr Neena Malhotra (AIIMS), Dr Sunil Jindal (Meerut), Dr Suneeta Mittal (New Delhi), Dr Anjani K Agarwal (New Delhi), Dr Bishwaranjan Dash (New Delhi)

Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan – e– Hindustan – Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Contact: Address: E –23 Ayurvigyan Nagar New Delhi – 110049, For details contact +91 9871250235

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  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Phosphorus test is most often ordered along with other tests, such as those for calcium, parathyroid hormone (PTH), and/or vitamin D, to help diagnose and/or monitor treatment of various conditions that cause calcium and phosphorus imbalances.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was diagnosed with sarcopenia.
Dr. Bad: It is related to diabetes.
Dr. Good: It is not related to diabetes.
Lesson: In the Korean Sarcopenic Obesity Study (KSOS), type 2 diabetes was associated with increased risk of sarcopenia. These characteristics may contribute to physical disability and metabolic disorders in older adults with diabetes (Diabetes Care 2010 July;33(7):1497–9).

For comments and archives

Make Sure

Situation: A patient who had multiple blunt trauma on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt trauma to exclude peritoneal haemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

For comments and archives

  Quote of the Day

(Dr Chandresh Jardosh)

First, have a definite, clear practical idea; a goal, an objective. Second, have the necessary means to achieve your ends; wisdom, money, materials, and methods. Third, adjust all your means to that end. Aristotle


Haste makes waste: Quickly doing things results in a poor ending.

    Medicolegal Update

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

The implied duty of doctor is not the guarantee of cure but to treat the case with diligence and skill

The Connecticut court focused on the word "ordinary"…A physician and surgeon, in the performance of his professional duties, is liable for injuries resulting from the want of ordinary diligence, care and skill……"Ordinary" means usual, common…If in the performance of any operation there was a want of ordinary diligence, care, and skill, or if there was carelessness, then the defendant–physician is liable.

  • The implied contract of a physician or surgeon is not to cure...but to treat the case with diligence and skill. The question is…whether the doctor had employed such skill and diligence as are ordinarily exercised in his profession…… The rule (is) to be reasonable…The law demands…not extraordinary skill such as belongs only to a few men of rare genius and endowments, but that degree which ordinarily characterizes the profession.
  • In 1860, the Supreme Court of Illinois issued its first decision on what constitutes the standard of care of a medical physician. The lawsuit claimed that a physician, who incidentally was represented by a then–practicing attorney named Abraham Lincoln, had been negligent for improperly applying a cast to treat a wrist fracture that had been sustained by the plaintiff. The court declared
  • When a person assumes the profession of physician and surgeon, he must…be held to employ a reasonable amount of skill and care. For anything short of that degree of skill in his practice, the law will hold him responsible for any injury which may result from its absence.
  • While he is not required to possess the highest order of qualification, to which men attain, still he must possess and exercise that degree of skill which is ordinarily possessed by members of the profession. And whether the injury results from a want of skill or the want of its application, he will, in either case, be equally liable.

For comments and archives

    Mind Teaser

Read this…………………

All of the following statements regarding vas deference are true except:

1. The terminal part is dilated to form ampulla.
2. It crosses ureter in the region of ischial spine.
3. It passes lateral to inferior epigastric artery at deep inguinal ring.
4. It is separated from the base of bladder by the peritoneum.

Yesterday’s Mind Teaser: Job I’m Job

Answer for yesterday’s Mind Teaser: I’m between jobs

Correct answers received from: Dr Amit Kochar, Dr Anurag julka, Dr Neelam Ohri, Dr KV Sarma,
Dr Chandresh Jardosh, Dr YJ Vasavada, Dr K Raju, Dr Muthumperumal Thirumalpillai, Dr Anil Bairaria.

Answer for 5th September Mind Teaser: 3. It should be expected in anyone receiving > 5 mg prednisolone daily.
Correct answers received from: Dr BB Aggarwal, Dr YJ Vasavada, Dr Deepali Chatterjee,
Prabha Sanghi.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

New Disease

A recent college graduate took a new job in a hilly Eastern city and began commuting each day to work through a tiring array of tunnels, bridges and traffic jams. Thinking it would make the trip more bearable, he invited several coworkers to share the ride. However, the commute actually got more stressful, especially the trips through the tunnels. He consulted the company doctor.

"Doc," the frustrated commuter complained, "I’m fine on the bridges, in the traffic, in the day and at night, and even when Joe forgets to bathe all week. But now, when I get in the tunnels with those four other guys crowded into the car, I get anxious and dizzy, and I feel like I’m going to explode."

Without further analysis, the doctor announced he had diagnosed the ailment. "What is it, Doc? Am I going insane?"

"No, no, no, my boy. You have something that is becoming more and more common." "Tell me! What is it?"

"You have what is known as Carpool Tunnel Syndrome."

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name


DCI Approval Date

Ferric Carboxymaltose equivalent to elemental Iron…50mg/ml Injection

For the treatment of iron deficiency in adults when oral iron preparations are ineffective or cannot be used.


    Public Forum

(Press Release for use by the newspapers)

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

Anmol – School Festival for Children with Special Needs

Anmol – Interschool Festival for Children with Special Needs will be organized on Monday, 17th October, 2011 as part of 18thMTNL Perfect Health Mela.

The festival will be organized by Heart Care Foundation of India, Department of Health, Government of Delhi, NDMC, MCD and World Fellowship of Religions in association with Balwant Rai Mehta School at the school premises at Kalkaji. Over 30 NCR schools will be participating in the event.

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President of Heart Care Foundation of India and MTNL Perfect Health Mela said that this unique event is organized every year to spread the message in the community that these children are not disabled or handicapped, they are only differently abled. If they lose one of the faculties in the body, they compensate it by cultivating some other faculty.

This year theme for the competition is Science behind rituals. The competition will include painting, cartoon making, collage making, rangoli making, dance etc.

For comments and archives

    Readers Responses
  1. What a coincidence !!!! happy birthday on a teachers day!!! Manish Kothari
  2. A many many happy return’s of the day. May god fulfill all your dream and you flourish in your life. Monosheesh Roy
  3. Happ birthday sir, u always remains my inspiration. I always watched Healthy India and u. Jyoti Prakash
  4. Many happy returs of the day. D R Lohar
  5. "Many Happy Returns of the Day" GOD Bless you with everything you wish in your life. Dr. Satish Mehta…
  6. Wishing you gud luck on your birthday, your contribution to the society is unmatchable… Vinesh Midha
  7. I’m wishing you another year, Of laughter, joy and fun, Surprises, love and happiness. Have a delightful Birthday, KK… ! Vinay Walia
  8. My dear KK, wishing you a fulfilling birthday evening and a year of abundance ahead. Ashok Khurana
  9. This day owes its importance to one of the greatest teachers of india… dr. radhakrishnan and now also another great pride of this country. Dr. KK Aggarwal………… happy birthday sir and happy teacher’s day too…Akshima Marwah
  10. Wish u A Very Happy B’day…… May u Live Long with Lots of Happiness & prosperity……… God Bless U……… Dr Saurabh Sharma
  11. "What do you think of God," the teacher asked. After a pause, the young pupil replied, "He’s not a think, he’s a feel." whenever i think of you as a physician, I found a healer. Your birth has a meaning for Humanity. HAPPY BIRTH DAY SIR. Manoj Khandelwal
  12. Sir, A very Happy Birthday to you! Ritu Ijcp
  13. Sirjee, happy birthday!! & YES happy Teacher’s day to the greatest teacher for all medicos… Shirish Singhal
  14. Healthy & Wealthy birth day wishes for a prosperous life ……Harish Khurana
  15. Aapko apna 18yrs+35yrs of experience Mubarak ho Sir… May God give you lots of years of experience ahead…& Happy Teacher’s Day… Sameer Gupta
  16. Dr.KK Wish you a Happy birthday. May God give you more strength, stamina to serve the humanity. Girish Tyagi
  17. I found guidance, friendship, discipline, and… love for all, everything, in one person And that person is you…Happy Birthday SIR…Anupam Sethi Malhotra
  18. Wishing you a great day sir–so wonderful that you share the birthday with such a great teacher for you are one too….Ananda Balayogi Bhavanani
  19. Salutation to the noble Guru, who has made it possible to realise the state which pervades the entire cosmos, everything animate and inanimate. Salutation to the noble Guru, who has opened the eyes blinded by darkness of ignorance with the collyrium–stick of knowledge. happy teacher’s day sir…Anupam Sethi Malhotra
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


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


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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