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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

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eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

8th April 2013, Monday

Every arthritis is not same

Every arthritis is not the same. While osteoarthritis, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammation arthritis called rheumatoid arthritis, if not treated early and aggressively can end up with serious deforming complications

Any arthritis in young women of child-bearing age should not be ignored, especially if it is worse in the morning and improves by movement. Most of them will have high platelet count on blood examination. These patients require aggressive treatment with disease-modifying drugs within days of the onset of symptoms and diagnosis. Approximately 1-2% of population may have this type of disease.

Osteoarthritis, on the other hand, is a disease of age 50+ and is due to wear and tear of various joints in the body and break down of the cartilage cushion in the joints. It mainly affects the weight-bearing joints like the knees, hips, neck and lower back joints.

Inflammation is not a major feature of osteoarthritis. The experts said that another form of joint disorder is due to gout which is never seen in people below 40 years of age and is almost never seen in young women before the onset of menopause unless there is a known underlying kidney disease and never seen in children.

The progression of osteoarthritis can be arrested with appropriate exercises, weight reduction and preventing posture and movement that worsen the disease.

Typical wear and tear of osteoarthritis is caused by sitting cross legged, doing Padmasana, squatting, other non physiological postures, sitting on low level surface like floor and low chairs, doing push ups, going up and down on stairs, etc.

Most yoga postures should be done under medical supervision and should follow with a counter yoga exercise.

Most patients of serious arthritis end up with treatment with other systems of medicines or with quacks.

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

Exercise impact on the knee

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

WHO Day Celebrated Over 11459 people trained in Hands Only Cardiopulmonary Resuscitation (CPR 10) in one day

The Event was organized by Heart Care Foundation of India. Heart Care Foundation of India created a world record by training over 10000 people in Hands Only CPR 10 in one day.

Dr K K Aggarwal
    National News

More Indians opting for virtual healthcare services: Study

NEW DELHI: A growing number of Indians are looking to more efficient healthcare services and are open to options like telemedicine and video-conferencing with doctors, a study by Cisco said. According to a customer experience study by networking solutions provider Cisco, 88 per cent of the Indians surveyed are comfortable with interacting with their doctors virtually instead of meeting them in person.
"87 per cent of the consumers surveyed in India would trust technology to determine whether or not they need to see a doctor," the report said. The global report conducted in early 2013 included 1,547 consumers and healthcare decision makers with a sample size of about 200 respondents in each of the 10 countries covered. The study report also revealed that 94 per cent of the respondents are willing to store their health records in the cloud with a high degree of security to enable them and their healthcare provider to access data easily.
"Nearly half of all consumers surveyed said they would be comfortable getting health information through social media channels," the study said. More than 50 per cent of consumers surveyed said they would be interested if their healthcare provider presented appointment reminder, information for managing drug side effects and treatment reminders via social media, it added.
"Virtual healthcare is no longer a myth and this report is an indication of how technology can potentially play a greater role in enabling access to virtual healthcare," Cisco VP/General Manager (Global Healthcare Solutions) Vishal Gupta said. As machines become connected and networked, they will play a larger role in the overall healthcare experience, he added. Accessing health information on mobile devices is growing and is the number one topic of consumer interest in India, Mexico, Brazil and China, the study said, adding, "Nearly 30 per cent of those surveyed in India confirmed using health and fitness or medical apps on their mobiles." (Source: TOI, Apr 3, 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)


Physical abuse in children

  1. Physical neglect– Failure to provide adequate food, clothing, shelter, hygiene, protection; inadequate supervision with risk of harm to the child.
  2. Emotional neglect– Failure to provide love, affection, security, and emotional support; failure to provide psychological care when needed; spouse abuse in presence of the child.
  3. Educational neglect– Failure to enroll the child in school or ensure school attendance or home schooling; failure to address specific educational needs.
  4. Medical neglect– Refusal to seek or delay in seeking medical care resulting in damage or risk of damage to the child’s health.

For comments and archives

    Valvular Heart Disease Update

Valvular thickening or sclerosis of the aortic and mitral valve is a frequent occurrence in hemodialysis patients and occur in 55 to 69 percent of individuals.

(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)

Fracture rate high in dialysis patients

The hip fracture rate among older dialysis patients is still higher now than it was in the 1990s, but the fractures are less deadly than they once were, researchers reported. (Source: Medpage Today)

Will the world population stabilize after 2050?

The population on earth will stabilize around the middle of the century, scientists have predicted. The findings, obtained with a model used by physicists, coincide with UN's downward forecasts , Spain-based Scientific Information and News Service reported. According to UN, the world population in 2100 will be within a range between 15.8 billion according to the highest estimates and 6.2 billion according to the lowest a figure that stands below the current 7 billion. (Source: TOI, Apr 6, 2013)

Stroke may trigger chronic pain

Roughly one in every 10 patients who suffer an ischemic stroke will develop a new chronic pain syndrome, which might increase the risk of cognitive and functional decline, researchers found. (Source: Medpage Today)

C. diff dangerous in ESRD

Patients on kidney dialysis who are infected with Clostridium difficile appeared to have a greater risk of infection relapse and also appeared to have a higher all-cause mortality that patients who do not have kidney disease, researchers said t the National Kidney Foundation 2013 Spring Clinical Meetings. (Source: Medpage Today)

Morning-after pill must be OTC for all ages, judge rules

In a decision praised by several leading medical societies, a federal judge today ordered the US Food and Drug Administration (FDA) to make an emergency oral contraceptive known as the morning-after pill available to all adolescent girls without a prescription within 30 days. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Tips on family history of high cholesterol http://blog.kkaggarwal.com/2013/04/tips-on-family-history-of-high-cholesterol/ …

@DrKKAggarwal: One of the most challenging obstacle addicts face is relapse. Pls read this article of our addiction expert http://tinyurl.com/b5dcsyy

    Spiritual Update

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

Wahans (Vehicles) In Mythology

In mythological era, the negative tendency of a man is symbolized with the animal nature. Also Gods in Indian mythology are symbolized by living a positive behavior. Every God has been given a vehicle or Wahan. Both God and the Wahan symbolized how to live a positive life and how to control the animal tendencies.

For comments and archives

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

How do counseling and support groups help those couples who are suffering from infertility?

Infertility at any age is a stressful experience, and counseling or support groups can be helpful. The intrusive nature of infertility testing and treatment can make you feel stressed or out of control. Feelings of sadness, anger, blame, guilt, depression, and loss are normal and can be overwhelming at times. Discussing your concerns with your partner, medical staff, and supportive people in your life is important. It may be helpful to join a support group or see a therapist.

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

(Dr Sanjay Chaudhary, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre)

Myth: Removal of eyes causes disfigurement of the face.
Fact: Removal of eyes does not produce any disfigurement of the face.

For comments and archives

    An Inspirational Story

Two Frogs in the Milk

This is the story of two frogs. One frog was fat and the other skinny. One day, while searching for food, they inadvertently jumped into a vat of milk. They couldn't get out, as the sides were too slippery, so they were just swimming around.

The fat frog said to the skinny frog, "Brother frog, there's no use paddling any longer. We're just going to drown, so we might as well give up." The skinny frog replied, "Hold on brother, keep paddling. Somebody will get us out." And they continued paddling for hours.

After a while, the fat frog said, "Brother frog, there's no use. I'm becoming very tired now. I'm just going to stop paddling and drown. It's Sunday and nobody's working. We're doomed. There's no possible way out of here." But the skinny frog said, "Keep trying. Keep paddling. Something will happen, keep paddling." Another couple of hours passed.

The fat frog said, "I can't go on any longer. There's no sense in doing it because we're going to drown anyway. What's the use?" And the fat frog stopped. He gave up. And he drowned in the milk. But the skinny frog kept on paddling.

Ten minutes later, the skinny frog felt something solid beneath his feet. He had churned the milk into butter and he hopped out of the vat.

For comments and archives

  Cardiology eMedinewS

Indian Medical entrance test discriminatory to NRI students: Indian community bodies Read More

  Pediatric eMedinewS

FDA OKs carbinoxamine ER for allergic rhinitis in children 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 are the consequences of a vaccine with a higher potency?

There are no risks with vaccine with a higher potency.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with community–acquired pneumonia was put on 750 mg levofloxacin.
Dr Bad: Take 500 mg for 10 days.
Dr Good: Take it for 5 days.
Lesson: The anti–pneumococcal fluoroquinolones (e.g., levofloxacin, moxifloxacin, gemifloxacin) have been used for 5 to 14 days in inpatients and outpatients with community–acquired pneumonia with most patients having a good clinical response within 2 to 3 days. Using a higher dose of a levofloxacin may decrease the duration of therapy; 750 mg for five days was as effective as 500 mg for 10 days and was associated with a more rapid resolution of fever (Clin Infect Dis 2003;37:752–60).

Make Sure

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

  Quote of the Day (Dr GM Singh)

Man’s troubles are rooted in extreme attention to senses, thoughts, and imagination. Attention should be focused internally to experience a quiet body and a calm mind. Buddha

    Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Can a metally ill person vote in an election?

QUESTION—Can a metally ill person vote in an election?


  • Every person whose name is registered in an electoral roll is eligible for voting.
  • A person who is of unsound mind and stands so declared by a competent court is not eligible to have his name registered in an electoral roll.
  • Section 16(1) of the Representation of the People Act, 1950, is reproduced below:
    “16. Disqualifications for registration in an electoral roll
    (1) A person shall be disqualified for registration in an electoral roll if he-
    • is not a citizen of India; or
    • is of unsound mind and stands so declared by a competent court; or
    • is for the time being disqualified from voting under the provisions of any law relating to corrupt 47[***] practices and other offences in connection with elections.”

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    Mind Teaser

Read this…………………

A 45-year-old male patient reports pain in his foot that moves up along his calf. The patient states, "My right foot feels like it is on fire." The patient further describes that he has no previous history of injuries or falls, and that his pain started yesterday. Which components of pain assessment has the patient reported?

1. Aggravating and alleviating factors
2. Exacerbation, and associated signs and symptoms
3. Intensity, temporal characteristics, and functional impact
4. Location, quality, and onset

Yesterday’s Mind Teaser: When assessing a patient for possible side effects related to acetaminophen (Tylenol), the pain management nurse asks the patient about the use of:

1. alcohol.
2. marijuana.
3. opioids.
4. tobacco.

Answer for Yesterday’s  Mind Teaser: alcohol.

Correct answers received from: Dr. Bharat Bhushan Aggarwal, Arundhati Malviya, Dr Arpan Gandhi, drjella, Dr.Suresh Arora, DR.JAYASHREE SEN & DR.BITAAN SEN, Dr. Deepali chatterjee, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai

Answer for 6th April Mind Teaser: c. Sitting in an infant seat

Correct answers received from: Dr Avtar Krishan

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Doctor, Doctor Have you got something for a bad headache?

Doc: Of course. Just take this hammer and smash yourself in the head.
Then you’ll have a bad headache.

    Medicolegal Update

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

Postmortem examination in death due to Adverse Events Following Immunization (AEFI)

The detailed history of the patient is included in the autopsy form that is submitted to the team (Autopsy Surgeon/Pathologist/Forensic Specialist) conducting autopsy. The additional specific information to the autopsy team will help them look for any underlying disease/pathologies in the deceased which may be cause of death or contributed in the cause of death.

  • It is recommended that an autopsy in a death suspected to be due to an AEFI be performed as soon as possible (within 72 hours) to avoid tissue damage, development of postmortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
  • Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference laboratories through investigating police agencies. The samples should be collected and transported to forensic laboratories as early as possible to avoid loss of biological samples due to decomposition.
  • All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.
  • Sampling for histopathology examination to be sent to pathologist for underlying disease/pathologies in the deceased which may be the cause of death or contributed in the cause of death: The samples should be representative of the suspicious area of disease/pathology; however, in general 80 to 100 gms of liver, 100 gms of brain with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of Spleen and whole heart should be taken.
  • All the visceral specimens should be collected in separate containers, a wide – mouthed bottle as prescribed and 10% formalin should be added as preservatives. The quantity of the formalin 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 pathological examination.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Heart Patients Beware of Summer

Dehydration can precipitate heart attack in susceptible individuals. The normal fluid requirement is 30 ml per kg weight, but the same needs to be increased in the summer because of the loss of fluid from sweating. Apart from water, Sodium or salt is also lost. A person, therefore, needs to take more fruits intake during summer period.

Not passing urine in eight hours, dry armpits, feeling exhausted or feeling week are suggestive of underlying dehydration said Padmashri and Dr B C Roy national Awardee Dr K K Aggarwal President Heart Care Foundation of India and National President Elect IMA. Dehydration can make the blood thick and precipitate heart attack in patients with uncontrolled blood pressure or diabetes.

Walking is a necessity for heart patients and the same should be continued even during peak summer but the timing should be so chosen that peak heat periods are avoided. One can walk early in the morning or late in the evening. People taking anti-allergic pills should take special precautions as they are more likely to get heat stroke.

Heat stroke is a medical emergency leading to charring of organs because of extreme internal heat. A person’s temperature may be more than 105°F.

Preventing Summer Disorders The most common summer disorders are dehydration, heat cramps, heat exhaustion and heat stroke on one hand and acidity, infections, diarrhea, cholera, typhoid and jaundice on the other hand.

Heat cramps, exhaustion and stroke all result from prolonged exposure to heat but differ in the severity of the illness. Heat cramp is a milder form of illness where a person ends up with weakness, dehydration, and salt deficiency. The treatment, is replacing fluid and salt orally.

Heat exhaustion, on the other hand, is a relatively serious condition with fever, dehydration, weakness but presence of sweating. If not diagnosed and treated in time with rapid fluid replacement, heat exhaustion can end–up into heat stroke where the body’s thermoregulatory mechanisms fail leading to a sudden rise in internal temperature and charring of organs and ultimate death.

Heat stroke, therefore, is a medical emergency and requires bringing down of temperature within minutes. Absence of sweating, dry armpit, non-passing of urine for eight hours or presence of high grade fever in summer season should not be ignored and medical attention taken immediately.

Diarrhea, Cholera, Typhoid and Jaundice are all food and water-born diseases due to poor hygiene and shortage of water supply in the community. All of them can become serious if not attended in time. Of these diarrhea and cholera are infections of the small intestine and require replacing with lemon water mixed with sugar and salt. The deficiency of fluid may be upto 6 to 8 liters. A person needs to be hospitalized only if the loose motions are more than 12 in number. For prevention of these diseases, one needs to follow the principle – Heat it, Boil it, Cook it, Peel it or Forget it.

    Readers Response
  1. Dear Sir, Congratulations for the Record. Regards: Dr Sarthak
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