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

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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal

8th February 2013, Friday

Swine Flu is back but no panic

57 cases of Swine Flu have been recorded in Delhi with three deaths.

Do not panic as this does not mean that for every 57 cases, three will die. This only means that 57 laboratory confirmed cases have been reported. There will be a large number of who have not got tested.

Mortality is high in patients who are pregnant or have underlying heart disease or other organ damage disease. Routine people do not have to worry.

  • Swine flu presents with fever of more than 100°F with cough or sore throat in the absence of any other main cause.
  • The diagnosis is confirmed with a lab test using rRT/PCR technique.
  • Mild or uncomplicated flu or Swine Flu is characterized by fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting. In mild cases, there is no shortness of breath.
  • Progressive swine flu is characterized by above symptoms along with chest pain, increased respiratory rate, decreased oxygen in the blood, labored breathing in children, low blood pressure, confusion, altered mental status, severe dehydration and exacerbation of underlying asthma, renal failure, diabetes, heart failure, angina or COPD.
  • Severe or complicated swine flu is characterized by respiratory failure, requirement of oxygen or ventilator, abnormal chest x-ray, inflammation of the brain, lowering of blood pressure to less than 60 and involvement of the heart muscle. These patients will have persistent high fever and other symptoms lasting more than three days.
  • Most patients will remain asthmatic with illness lasting 3-7 days.
  • The other characteristic features are presence of chills, muscle pain and joint pain.
  • In the pregnant women, flu can cause more serious complications including death of fetus.
  • Patients at extreme of ages are at risk. Mild cases do not require admission but progressive cases need to be admitted.
  • Older age, underlying, organ disease and requirement of mechanical ventilation is the indication for admission.
  • Tamiflu (oseltamivir phosphate) is the treatment of choice but it should be taken under medical supervision. But it has to be given in the first 48 hours. It is given in severely low patients, pregnant women, underlying organ disease or age less than 5 and more than 65 years.
  • Flu vaccine can be given to all. It should be given to all high-risk patients.
  • The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet.
  • Stay 3 feet away from the person who is coughing.

The standard prevention is respiratory hygiene, cough etiquette and hand hygiene.

  • Hand washing should be performed before and after every patient contact or infectious material and before putting and after removing gloves.
  • Hand hygiene can be performed by washing with soap, water and with alcohol based hand drops.
  • If hands are visibly soiled, they should be washed with soap and water.
  • Patients should be placed in a private room or area. The health care staff should wear a face mask while entering the patient’s room. When leaving the room, the health care workers should remove the face mask, dispose it off and then perform hand hygiene.
  • Patients should wear a surgical mask and should be aware of respiratory hygiene, cough etiquette and hand hygiene.
  • Droplet precaution should be taken for seven days after illness onset or 24 hours after resolutions of fever and respiratory syndrome.
  • One should not cough in the hands, handkerchief but instead cough either in the tissue paper and dispose it off or in the side of the arm.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

A trial of osmotic laxatives should be considered in patients not responding to bulking agents.

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Give thiazides only to obese hypertensives

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

CPR 10 camp at Mount Abu School, Rohini

Dr. KK Aggarwal, President Heart Care Foundation of India and Ms Jyoti Arora Principal said that learning and passing on the knowledge about hands-only CPR is the best gift one can give to others.

Dr K K Aggarwal
    National News

New body to check paramedical institutes, staff

JAIPUR: Support staff (paramedics) in hospitals and paramedical education colleges will be regulated for better healthcare facilities with the setting up of the Rajasthan Paramedical Council (RPC) by the state medical health and family welfare department recently. The RPC set up on Wednesday will standardize not only paramedics' practices but also the paramedical education. "We have separate regulatory bodies for doctors and nurses, but we did not have a regulatory body for the paramedics and paramedic education, so a new council for paramedical has been formed," Medical health and family welfare department joint secretary Chunnilal Kayal said. The RPC will be responsible for ensuring that paramedics will provide better healthcare facilities to the people. Under the newly constituted regulatory body for paramedics and paramedic education, each paramedic will have to get registered. The RPC will also frame rules for paramedics and paramedic education to ensure that uniform standard for paramedical education remains intact. (Source: TOI, Feb 4, 2013)

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)


In sexual assault child, sexually transmitted illnesses should be checked for.

    Valvular Heart Disease Update

When is surgery indicated in an asymptomatic patient with flail leaflet and severe MR?

For asymptomatic patients with severe MR, surgical correction should be considered early in the course of the disease if valve repair is feasible with a >90 percent likelihood of success.

(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)

Coronary calcium identifies prehypertensives at high risk of CV events

Coronary calcium is a key predictor of which patients with prehypertension will go on to have cardiovascular events, particularly in women, according to data from the Heinz Nixdorf RECALL study presented here at the 2013 International Conference on Prehypertension and Cardiometabolic Syndrome. (Source: Medscape)

Generic Doxil gets green light

The FDA has approved a generic version of the cancer agent Doxil, which is currently on the agency's list of drugs in short supply. (Source: Medpage Today)

How not to get hypertension: Some clues from HARVEST

New results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST) are offering a glimpse at a group typically overlooked in hypertension studies: people who manage to avoid developing the disease over the long term. Dr Paolo Palatini (University of Padova, Italy) presented the findings here at the 2013 International Conference on Prehypertension and Cardiometabolic Syndrome. (Source: Medscape)

Low sperm count tied to high TV time

Today's couch potatoes could turn into tomorrow's reproductively challenged spuds, according to results of a study linking TV time to poorer sperm quality in young men. (Source: Medpage Today)

No survival gain seen from beta-blockers in heart failure with AF

A new meta-analysis suggests that beta-blockers have little effect in heart-failure (HF) patients with atrial fibrillation (AF). The review included trials examining the four beta-blockers currently licensed for use in HF: bisoprolol, metoprolol controlled release (CR), nebivolol and carvedilol. (Source: Medscape)

   Twitter of the Day

@DrKKAggarwal: AJCC In a pair of new guideline documents, the World Health Organization (WHO) recommends a maximum daily intake...http://fb.me/ZLQYvt1s

@DeepakChopra: Our life is an unfolding of the unknown #CosmicConsciousness

    Spiritual Update

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

Understanding exact speech

The Upanishads, Yogasutra of Patanjali and teachings of Gautam Buddha all talk about “the right speech”. As per Gautam Buddha, it has three components:

  • It should be based on truthfulness.
  • It should be necessary.
  • It should be kind

For comments and archives

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

What is endometrial ablation?

Endometrial ablation is a medical procedure that removes the lining of the uterus, called the endometrium. If your periods are very heavy or last too long, your health care provider may prescribe medications that will cause you to have a lighter period. If the medication does not work, your health care provider may recommend endometrial ablation.

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

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

Can blood of animals be transfused to human beings?

Scientists have made several attempts, but so far they have not been successful. Only the blood of a human being can be transfused to a human patient

For comments and archives

   An Inspirational Story

Good news or Bad news

Robert De Vincenzo, the great Argentine golfer, once won a tournament and, after receiving the check and smiling for the cameras, he went to the clubhouse and prepared to leave. Some time later, he walked alone to his car in the parking lot and was approached by a young woman. She congratulated him on his victory and then told him that her child was seriously ill and near death. She did not know how she could pay the doctor’s bills and hospital expenses.

De Vincenzo was touched by her story, and he took out a pen and endorsed his winning check for payment to the woman. "Make some good days for the baby," he said as he pressed the check into her hand.

The next week he was having lunch in a country club when a Professional Golf Association official came to his table. "Some of the boys in the parking lot last week told me you met a young woman there after you won that tournament." De Vincenzo nodded. "Well," said the official, "I have news for you. She’s a phony. She has no sick baby. She’s not even married. She fleeced you, my friend."

"You mean there is no baby who is dying?" said De Vincenzo.

"That’s right," said the official.

"That’s the best good news I’ve heard all week." De Vincenzo said.

Moral: Good news or bad news? It depends on how you see things. You can be bitter after cheated. Or you can choose to move on with your life.......

For comments and archives

   Cardiology eMedinewS

Cardiac disease: Independent risk factor for MCI Read More

Drug-resistant fungi new hospital menace Read More

   Pediatric eMedinewS

NSAIDs linked to acute kidney injury in dehydrated kids Read More

Sonographic markers related to risk for Trisomy 21 Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with mild cognitive impairment.
Dr. Bad: No treatment is needed.
Dr. Good: You need to change your lifestyle, stop smoking and reduce alcohol consumption.
Lesson: Modifiable risk factors for mild cognitive impairment should be sought (at the very latest) in persons who already have mild cognitive impairment, as their optimal treatment may improve these patients' cognitive performance or keep the existing deficits from progressing. Epidemiological data suggest that a Mediterranean diet, physical activity, and moderate alcohol consumption protect against MCI, while cigarette smoking promotes it and should be stopped (Dtsch Arztebl Int 2011 Nov;108(44):743-50).

Make Sure

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

  Quote of the Day (Dr GM Singh)

Fate leads the willing, and drags along the reluctant. Lucius Annaeus Seneca

    Mind Teaser

Read this…………………

So that the blood may flow from the right ventricle to the pulmonary artery, which of the following conditions is NOT required?

a. The atrioventricular valves must be closed
b. The pulmonic valve must be open
c. Right ventricular pressure must be less than pulmonary arterial pressure
d. Right ventricular pressure must rise with systole

Yesterday’s Mind Teaser: The intrinsic pacemaker rate of ventricular myocardial cells is:

a. More than 80 bpm
b. 60 t0 80 bpm
c. 40 to 60 bpm
d. Fewer than 40 bpm

Answer for yesterday’s Mind Teaser: d. Fewer than 40 bpm

Correct answers received from: Dr Arpan Gandhi, Dr PC Das, Dr Bharat Bhushan Aggarwal, Dr KV Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Kanta Jain, Dr Avtar Krishan, Muthumperumal Thirumalpillai.

Answer for 6th February Mind Teaser: A. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system.”

Correct answers received from: Muthumperumal Thirumalpillai.

Send your answer to ijcp12@gmail.com

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Laugh a While (Dr GM Singh)

Q: What's the difference between an intelligent man and a UFO?

A: Don’t know, haven’t seen any.

    Medicolegal Update

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

Autopsy in death due to adverse events following immunization (AEFI)

The doctor conducting the autopsy is duty bound to take samples for toxicological screening and send them to Forensic Laboratory for toxicological/chemical examination

  • The injection site and the tissues underneath up to 2–3 cms (button size) with dermis and epidermis of the sight of injection prick should be excised out. It should be preserved in a glass jar, which should be filled two–thirds with saturated saline water. The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further toxicological/chemical examination.
  • Viscera for toxicological/chemical examination: The following viscera specimen/biological samples should be collected for toxicological/chemical examination (80-100 gms of liver, 80-100 gms of brain with meninges, whole of the stomach with gastric contents (If no gastric contents, a section of stomach should be sent), upper part of small intestine about 30cm long with its contents, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen, blood (100 ml ideal/minimum 10 ml) and urine (100 ml/minimum 10 ml).
  • All the visceral specimens should be collected in separate container a wide-mouthed bottle as prescribed and saturated saline should be added as preservatives. The quantity of the saline should be sufficient to cover all the pieces of specimen viscera in bottle.
  • The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further chemical examination in a forensic lab.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Idiopathic Dilated Cardiomyopathy Complicating a Pregnancy with Uterine Fibroid

Idiopathic dilated cardiomyopathy (DCM) during pregnancy is a rare coincidence. These patients can experience hazardous complications like cardiac failure and even death during pregnancy due to physiologically increase in vascular volume and cardiac output.

According to Dr Debasmita Mandal and colleagues from Dept. of Obstetrics and Gynecology, IPGME & R, SSKM Hospital, Kolkata, adequate prenatal and antenatal counselling and good multidisciplinary support may lead to successful pregnancy outcome in patients with idiopathic DCM. They report a case with 32% pumping heart along with a larger fibroid with successful cesarean delivery in the January 2013 issue of Indian Journal of Clinical practice.

Commenting on the study, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, Group Editor in Chief, IJCP said that low pumping heart can be present in pregnancy and it can also be a complication of post pregnancy state. Such deliveries should be done in established heart hospitals.

Low pumping heart is no more an indication for termination of pregnancy, said Dr Anita Kant Senior Gynecologist at Faridabad.

Giving the details of a CPR 10 camp, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that 1498 students in Hands-only Cardiopulmonary Resuscitation were trained. Ms Jyoti Arora, Principal, Mount Abu School, Rohini said that learning and passing on the knowledge about hands-only CPR is the best gift one can give to others.

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 27902 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, 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.”

    Readers Response
  1. Dear Editor, I feel that rather than ensuring avoidance of prescription error the move seems to be to ensure availability of medicines (by way of generic names) to the patient at cheaper rates. Dr. Narendra Kumar, Ophthacare Eye Centre.
    Forthcoming Events


Sri Aurobindo Ashram – Delhi Branch will organize the 6th Study Camp on ‘Mind-Body Medicine and Beyond’ for doctors, medical students and other health professionals at its Nainital Centre (Van Nivas) from June 8-14, 2013. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind-body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of the Mind-Body Medicine Clinic at AIIMS, and the author of Back to Health through Yoga, Eating Wisely and Well and Essays on Yoga. For more details, send an e-mail to the Ashram (aurobindo@vsnl.com) or to Dr. Bijlani (rambij@gmail.com).

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