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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

  Editorial ...

8th November 2010, Monday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Diwali pollution and health

Particulates or particulate matter (PM) or fine particles are tiny subdivisions of solid or liquid matter suspended in a gas or liquid. When suspended in air they are called Suspended Particulate Matter (SPM). Aerosol on the other hand refers to particles and the gas together. Particulate matter is generally sized as PM10 and PM2.5, the number indicating its size in microns. SPM bigger than 5 microns are trapped in the nasal membrane and are stopped from entering into the lungs but SPM smaller than these, cannot be stopped in the nasal tract and enter the lungs causing damage to the respiratory tract.

There is a known correlation between levels of SPM air pollution and lung disease. The association is with bronchitis and not asthma. A study of six cities in the United States showed a direct relationship between the levels of SPM pollution and reported rates of chronic cough and bronchitis. There was no association between particulate concentration and asthma, persistent wheeze, or hay fever. There occurs an increase in SPM levels pre and post Diwali, with an increase in the levels of sulphur dioxide and nitrogen dioxide.

The main presentation of Diwali respiratory illness is "symptom of hyper-reactive airways" presenting as "persistent dry cough and shortness of breath". It is medically also called as "reactive airways disease syndrome" or "RADs".  

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

"A country cannot simultaneously prepare and prevent war". Albert Einstein

    Photo Feature (from the HCFI Photo Gallery)

  Medico Masti - 17th MTNL Perfect Health Mela 2010

Vipin Aneja, performed live during Medico Masti event in the 17th MTNL Perfect Health Mela, he got the audience to its feet with his rendition of some peppy and foot tapping numbers.
In the photo: Vipin Aneja, a well-known singer Being felicitated by Heart Care Foundation of India at the 17th Perfect Health Mela, Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal and Dr Veena Aggarwal, Joint MD, IJCP Publications Pvt Ltd.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/ Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

India deep down in global poverty index

Eight Indian States are home to 421 million multi–dimensionally poor people, more than the figure of 410 million in 26 poorest African countries. The Multidimensional Poverty Index — which identifies serious simultaneous deprivations in health, education and income at the household level in 104 countries — brought out in the latest United Nations Human Development Report has calculated that South Asia is home to half of the world's multi–dimensionally poor population, or 844 million people. (Source: The Hindu)

    International News

Today is World Radiography Day 2010

World Radiography Day is an international initiative celebrated annually to commemorate the discovery of x–rays by Wilhelm Conrad Roentgen, a German physicist. On this day in 1895, Wilhelm Conrad Roentgen produced and detected electromagnetic radiation in a wavelength range today known as X–rays or Roentgen rays. He received the first Nobel Prize in Physics in 1901 for this. Roentgen passed away on 10 February 1923 in Munich, Germany. In keeping with his will, all his personal and scientific correspondence were destroyed upon his death.

The Day intends to raise awareness of, and to stimulate an interest in, the profession of radiography. In addition it is aimed at highlighting the importance of radiography and the indispensable function it plays in the health care environment.

(Dr Monica and Brahm Vasudev)

Health Tip: Don’t mix alcohol and drugs

There are certain over–the–counter drugs that can be particularly dangerous when taken with alcohol. The American Academy of Family Physicians says these OTC medications should never be taken with alcohol:

  • Nonsteroidal anti–inflammatory drugs (NSAIDs), such as ibuprofen, aspirin or naproxen.
  • Paracetamol
  • Antihistamines that tend to cause drowsiness
  • Medications to manage cough and congestion that contain dextromethorphan
  • Herbs, notably supplements that contain valerian root, kava kava or St. John’s wort

NSAIDs induce ulcers in some

Factors that can increase risk

  • Being age 60 or older
  • Having a history of internal bleeding or ulcers
  • Taking steroids such as prednisone, or blood thinners such as warfarin
  • Regularly using tobacco or alcohol
  • Having side effects from NSAIDs, such as heartburn or upset stomach
  • Using NSAIDs in greater doses than recommended, or using them long–term
  • Taking multiple medications that contain NSAIDs

Y– Chromosome’s and ‘Gothra’ (Dr Reshma)

http://www.boloji. com/astro/ 00324.htm

How was this genetic work done? Geneticists used a scientific fact, that most of the male Y–chromosome is passed intact from father to son. Females do not carry the Y–chromosome. With modern advances in genetics, this fact has been used to trace paternal lineage, and resolve stories like Thomas Jefferson's.

Thomas Jefferson did not have surviving sons from his legal wife. But his paternal uncle’s male lineage is in tact to present time. The genetic Y–chromosome of these persons (eight generations down from Thomas Jefferson’s paternal uncle) living at present time was used as the reference. This was compared with intact male line persons from (Five generations down from) Sally Fleming living presently. The geneticists used polymorphic markers so that Y–chromosome can be distinguished by haplotypes. They found that Sally Fleming’s son Eston’s male line progeny had same haplotypes as Field Jefferson who was paternal uncle of Thomas Jefferson. Using other physical and living proximity factors, the geneticists have concluded with high probability that Eston Fleming was the son of Thomas Jefferson and Sally Fleming.

This class of human male lineage research is now very active and is being conducted in native populations of Wales, England, in Iceland and to establish uniqueness, paternity, historical lineage, medical issues and intellectual issues of heredity etc amongst various population groups.
Does this not ring a bell amongst traditional Hindus who believe in ‘gothra’ identification carried down from Sanathana–dharma orthodoxy?.

‘Gothra’ is an identity carried by male lineage in India from time immemorial. Most people have gothra chain names traceable to Rig Vedic Rishis like ‘Gowthama’, ‘Vasishta’ ‘Viswamithra’ and to first sons of Vaivaswatha Manu like Angirasa & Bhrigu. Purana such as Vishnu Purana refer to individual identity through ‘Gothra’. Listings of more than 250 Gothra chains have been explicitly listed. I have heard of instances of Muslims converted from Hinduism still keeping track of their ‘Gothra’.

For example we know that Buddha, named Siddhartha was of ‘Gowthama Gothra’. It means that his Y–chromosomes were probably from Rig–Vedic Rishi ‘Gowthama Rahoogana’.

How did the people of 3000–4000 years ago realize that genetically there was transference of some unique characteristics only from father to son (in the form of Y–chromosomes) ? In recent past when it was fashionable to condemn all Indian traditional systems as of no value, non–believers have referred to ‘Gothra’ as archaic, unscientific, irrelevant and male chauvinistic!

Modern DNA & genetic research has confirmed male line Y–chromosomal transference, through 8 generations in case of Thomas Jefferson. ‘Gothra’ in essence really stands for Y–chromosomal identity.

Nearly 2500 years have passed since death of Buddha, but many ‘Gowthama Gothra’ individuals exist now also. They can claim genetic relation to Buddha. Typically 4 generations occur in 100 years and in 2500 years nearly 100 generations are complete. Other ‘Gothra’ chains may have run 100–200 generations from Vedic period if male lineage did continue unbroken. Do Y–chromosomes remain intact after, say 100 generations of unbroken male issues? Genetic mutations may or may not have changed some Y–chromosomes.

This appears to be a very interesting field of research for future to see if persons of same ‘Gothra’ in the present generations have common and unique Y–chromosomal features. – Dr S.Balakrishna, May 15 2000.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are the causes for female infertility?

Factors relating only to female infertility include age, smoking, sexually transmitted infections; being overweight or underweight can all affect fertility.

Age: Fertility starts declining after age 27 and drops at a somewhat greater rate after age 35. In terms of ovarian reserve, a typical woman has 12% of her reserve at age 30 and has only 3% at age 40. 81% of variation in ovarian reserve is due to age alone, making age the most important factor in female infertility.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

What is the nutritional management of IBD?

Nutrition is an integral part of the management of children with IBD, and nutritional status should be assessed at presentation and at follow–up. Exclusive enteral nutritional therapy modifies disease in children with CD. There are 2 types of enteral feeding: elemental (amino acids + short–chain fatty acids + short–chain carbohydrates + vitamins) and polymeric (whole protein). Elemental diets are very useful but are unpalatable, so polymeric diets are preferred in children. Therapy lasts for 6 weeks followed by gradual re–introduction of normal diet. Nutritional support should be considered as an adjunctive therapy for any patient with CD or UC with malnutrition. Nasogastric/gastrostomy tube feeding can be considered.

    Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is the treatment of poisonous bites and stings?

  • Antivenom should only be given in a hospital or medical center where resuscitation can be given, because the patient may develop an allergic reaction. Antivenin should be used, if there are signs of severe systemic envenoming. It should not be used when there are no signs of systemic envenoming. To decide whether venom has been injected, and how serious the poisoning is, look for these signs:
    • Swelling and local tissue injury at the site of the bite
    • Blood that does not clot, causing bleeding from gums, nose, wounds and injection sites
    • Shock caused by circulatory failure
    • Neurotoxic paralysis (ptosis, ophthalmoplegia, dysarthria, peripheral muscle weakness, respiratory distress)
    • Generalized muscle pain and local tissue damage
    • Kidney failure, red or black urine
    • Tender swollen lymph nodes near the bite site
  • To test clotting time of whole blood: Place 2–3 ml of whole venous blood in a clean, dry, glass test–tube and leave undisturbed for 20 minutes at room temperature. Normal blood should have clotted by this time. Tip the tube to see if the blood is still liquid.
  • If the wound becomes infected, treat as for any other local infection. Use antibiotics if needed.
  • If there is local tissue injury, do not cover the wound, instead leave it open.
    Interesting Website to know

Dr Jitendra Ingole, Asst Professor (Medicine), SKN Medical College, Pune


Design your own house plan and interior. You can create your own floor plan of house and can experiment with different ideas / directions of various furniture … all with a simple click. Moreover, it allows for 3–Dimensional view. Experience yourself!

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum lithium

To determine lithium levels in the blood in order to maintain a therapeutic level or to detect lithium toxicity.

    Medi Finance Update

Can a doctor claim any tax rebate on the tax calculated?

Yes, he can claim Tax rebate u/s 88 upto Rs. 20,000 or 20% of the gross qualifying investments in case is one lakh fifty thousand rupees or less. Rs. 15,000 or 15% income is more than Rs. 1,50,000 but does not exceed Rs. 5,00,000. Under section 88 B, if a person is above 65 years of age then upto Rs. 20,000. Under section 88 C, in case of a female below 65 years of age then upto Rs. 5,000.

    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Liquid oral tonic preparations containing glycerophosphates and/or other phosphates and / or central nervous system stimulant and such preparations containing alcohol more than 20% proof

    IMSA Update

International Medical Science Academy (IMSA) Update

Critical care in Asthma

A meta–analysis showed that adding a long–acting beta agonist (LABA) to an inhaled glucocorticoid in patients with asthma decreases asthma–related hospitalization. On the other hand, another meta–analysis found an increase in asthma–related intubation and mortality for the LABA–treated group.


  1. Nelson H, Bonuccelli C, Radner F, et al. Safety of formoterol in patients with asthma: combined analysis of data from double-blind, randomized controlled trials. J Allergy Clin Immunol 2010;125:390.
  2. Salpeter SR, Wall AJ, Buckley NS. Long–acting beta–agonists with and without inhaled corticosteroids and catastrophic asthma events. Am J Med 2010;123:322.
    IJCP Special

Dr Good Dr Bad

Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.
Dr Bad: Do not worry.
Dr Good: Rule out diabetes.
Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).

Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.

    Lighter Side of Reading

An Inspirational Story

Grandmother’s Vase

One day I was lying on the bed, reading, when my mother came into the room. She held out a vase––a rather ugly vase. She asked, ‘Would you like to have this vase?’ "I replied quickly, ‘No, I don’t want it.’ "As she turned to walk away, I picked up something that said to me, ‘Wait a minute, don’t shut this off yet.’ So I asked, ‘Where did you get it?’

"She said, ‘Oh, I got it when I filled an order.’ Filled an order? I thought––no communication here. So I asked, ‘What do you mean, filled an order?’ ‘Well,’ she said, ‘when I was a little girl, the Smith Company mailed catalogs to people. I would take the catalog around the neighborhood, and I’d get people to order from it. When I filled an order and sent it in, they gave me a prize. One time, I got a porch swing for my family.’

"Now you have to understand," said Hensley, "that my mother is 81–years–old. She is one of six children in a family that her father deserted when she was quite young. Money was real hard to come by. My grandmother managed to keep the family together through the years, although I don’t know how. For my mother to win a luxury like a porch swing was a significant accomplishment. Although she no longer had the swing, she had the vase––a vase full of meaning––which she offered to me. Instantly I said, ‘Mom, I want the vase.’ Now it sits in a prominent place in my living room.

It symbolizes a precious meaning which my mother and I share. Unless you and I are sensitive to the other person and hear meaning, we may well have a communication problem.

Mind Teaser

Read this…………………


Answer for yesterday’s Mind Teaser: "Capital punishment "

Correct answers received from: Dr Virender Prakash Gautam, Dr Rashmi Chhibber, Dr. K. P. Rajalakshmi, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai

Answer for 6th November Mind Teaser: "Working overtime"
Correct answers received from: Dr Marak, Dr Anupam

Send your answer to ijcp12@gmail.com

Humor Section
(Dr G M Singh)

Wife Vs Husband

A couple drove down a country road for several miles, not saying a word. An earlier discussion had led to an argument and neither of them wanted to concede their position. As they passed a barnyard of mules, goats, and pigs, the husband asked sarcastically, "Relatives of yours?"

"Yep," the wife replied, "in–laws."

    Readers Responses
  1. My Heartiest wishes of Diwali to Dear Dr KK Aggarwal and eMedinews team. Wish you all Happy Diwali. Dr Chandresh Jardosh.
  2. Aap sabhi ko India ke sabse bade tyohaar Deepawali  (5 dino ka) ki hardik shubkamnaaye..........!! Wishing You A Very Happy Diwali!! May you be blessed with happiness and well being to last through the year!!! Regards Dr Mamta Sharma.
    Public Forum

(Press Release for use by the newspapers)

X–ray can be normal in Pneumonia

A chest X–ray can be normal in the first 24 hours of pneumonia, as the disease may still be in its early stage said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

He said that pneumonia can be community–acquired or hospital–acquired. Community–acquired pneumonia is pneumonia that occurs in the community in a person without history of health care contact and can be treated by simple antibiotics. But if a person develops pneumonia within 48 hours of getting admitted to hospital or after 48 hours of endotracheal intubation, it is called hospital–acquired pneumonia. This pneumonia needs treatment with combination of costly antibiotics.

HCAP is healthcare–associated pneumonia that occurs in a non hospitalized patient but with extensive healthcare contact. It is a new concept and the public must avoid visits to the hospitals to avoid this as once the pneumonia develops, it requires costly antibiotics.

One should suspect HCAP if the patient in the last one month has received any intravenous therapy; has been going to a doctor for a wound care; has received intravenous chemotherapy; has visited a hospital setting or a hemodialysis clinic. It should also be suspected if the person was admitted to a hospital with acute care facilities in the last 3 months.

Uncomplicated community–acquired pneumonia (CAP) can be treated in a clinic as it has low mortality but patients with CAP who require admission have 37% mortality.

High–risk community–acquired pneumonia patients can be remembered by the formula CURB 65: C stands for confusion (anoxia), U stands for Urea more than 20 (pre renal azotemia), R stands for respiratory rate more than 30 per minute within (anoxia) and B stands for low blood pressure – systolic less than 90 and diastolic less than 60 (CO2 retention)

Any patient of community–acquired pneumonia who does not respond within 72 hours should be treated as high–risk patient. Pneumonia patients have low mortality if they have received pneumonia/flu vaccination in the past.

For community–acquired pneumonia treatment, one can treat only on the basis of clinical features and a chest X–ray. But in healthcare-associated pneumonia, sputum culture examination is also required.

Cough in pneumonia may last for a week and X–ray may take four weeks to clear in normal individuals and 12 weeks in the elderly. Repeat X–ray after one week of discharge is not necessary. However follow up X–ray is required at 8 to 12 weeks to document resolution of pneumonia and to exclude underlying malignancy.

For simple healthcare–associated pneumonia, where multidrug resistance is not suspected: Treat with IV ceftriaxone 2 g or Levofloxacin 750 mg daily or ampicillin–sulbactam 3 g IV every six hours. The best bet is to give 750 mg Levofloxacin every day.

    Forthcoming Events
eMedinewS Events: Register at emedinews@gmail.com

November 29, 2010, Monday, 9 AM – 1PM, Moolchand Medcity – “Update on Kidney Transplant”. No Fee. Entry by Invitation.  Contact: emedinews@gmail.com
eMedinewS Revisiting 2010

The 2nd eMedinewS  – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6PM – 9PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6PM – 2nd eMedinewS revisiting 2010, A Medical Update

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