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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 …

9th April, 2011, Saturday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Science behind Navratras

Traditionally, there are only three seasons – summer, winter and the rainy season. During rainy season, Chaturmas is observed as a period of mind, body and soul purification.

Whenever there is a change in season, the body needs an adaptation time to change behavior, lifestyle, diet and other daily routine. In our Shastras, this change–over period was designated as a time to purify and detoxify mind, body and soul and eat less carbohydrates cereals and taking a Satvik diet. The Shastras named this term as Nav Ratras.

The two Nav Ratras (Ramnavami Navratras and Dusshehra Navratras), therefore, come at the onset of summer and winter and are the designated nine days for detoxification of mind, body and soul. During this period, a person is supposed to lead a Satvik lifestyle which involves Satvik diet, Satvik behavior and Satvik thoughts. The Satvik diet means eating less, once in a day and avoiding carbohydrate–based cereals. One can eat non–carbohydrate flour – Kuttu ka atta or singhare ka aata etc. which are flower–based and not cereal based.

In Navratra puja, there is a ritual of worshipping wheat grass or barley grass. Wheat and barley grass juice are both known blood detoxifiers and instead of worshipping them, their juice should be consumed every day during Navratras.

Traditionally, Navratras involve pooja of Maa Kaali in the first three days; Maa Lakshmi the next three days and Maa Saraswati in the last three days. Kaali pooja involves restraining the mind from rajsik and tamsik behavior. Lakshmi pooja involves willfully adapting to a Satvik lifestyle including Satvik diet and behavior. Saraswati pooja involves reading and listening to Satvik literature.

The nine days of purification during Navratra are sufficient to build up immunity to cover the next four months. In the rainy season, as the immunity remains low, the entire four months are observed as Chaturmas or the months of purification.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

 Rheumatoid arthritis Update

Dr Harvinder S Luthra
Speaks on ‘Rheumatoid arthritis’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

11th Perfect Health Parade

The 11th Perfect Health Parade was organized to mark the World Health Day. In the photo: The parade in the form of Tableaus moving around the city to create awareness about various health aspects.

Dr K K Aggarwal
    National News

NGO uses biometrics to monitor TB patients

JAIPUR: In an innovative method, the biometrics attendance system is being used by an NGO in its bid to eradicate tuberculosis in the city which has about 217 per one lakh people afflicted by the disease. For the past six decades, the Centre has been fighting against the infectious diseases but has been unable to eradicate it completely. In its bid to eradicate the disease, Operation Asha has been using the biometric system to mark attendance of TB patients at their DOT centres. "If a patient skips medicines or discontinues taking a complete TB course with an impression that he has become healthy, then the disease would become more dreadful. Such person will spread the infection to other people also," Sandeep Ahuja, CEO of Operation Asha, said. The World Bank has also acknowledged the innovative idea of the NGO. It has selected Operation Asha along with 29 other social enterprises for its grants. Out of the 30 social enterprises, 13 would be provided with $50,000 by World Bank as grants. (Source: TOI, April 07, 2011)

Autism Awareness Day observed

GUWAHATI– Guwahati, along with the rest of the world celebrated World Autism Awareness Day on April 2, to make people aware about the lesser known neurological disorder among children that is gradually increasing. The disorder is often mistaken as mental disability, which often misleads its diagnosis and treatment. Assam Autism Foundation (AAF), a pioneer institute of autism in Assam took the lead in celebrating the day and hosted an awareness campaign in Nehru Stadium. The awareness programme was attended by various sections of the society including school students, college students, representatives of leading companies, musicians and nurses. Rajib Duarah, Director of Social Welfare while speaking as the chief guest of the function, said that autism would be taken up in 2011 in a big way as the awareness level is gradually increasing. “Amendments in the PWD Act for disability of 1995 are on the way and we can expect better facilities for these children,” he said. He also mentioned that training the children of autism is a very difficult task, and lauded the efforts of Assam Autism Foundation in this field. He also thanked the participants and other people for their concern and participation. (Source: The Assam Tribune, April 3, 2011)

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

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Increase antioxidant intake

Free radicals are electronically charged molecules within the body that attack other molecules, causing cellular damage, including damage to your skin. Antioxidants, including key vitamins and minerals counteract the effects of free radicals. You can increase your antioxidant intake by increasing the amount of fresh fruits and vegetables in your diet as well as taking a quality daily multivitamin and anti-aging regimen.

(Dr Monica and Brahm Vasudev)

FDA panel endorses new antibiotic for C. difficile

An FDA advisory committee has voted unanimously to recommend approval of the investigational narrow–spectrum antibiotic fidaxomicin (Dificid) to treat Clostridium difficile–associated diarrhea.

Acetaminophen intake during pregnancy may increase risk for childhood asthma

Mothers who use acetaminophen when they are pregnant may be placing their unborn children at risk for asthma, according to a study in the April issue of Clinical & Experimental Allergy.

Anticholinergic may be more effective than beta2–agonist for preventing COPD exacerbations

In patients with moderate to very severe chronic obstructive pulmonary disease (COPD) and a history of exacerbations in the preceding year, tiotropium appears to be superior to salmeterol in preventing exacerbations, according to a study in the New England Journal of Medicine.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with fever and joint pain came with rash.
Dr Bad: It’s a drug allergy.
Dr Good: It looks like Chikungunya.
Lesson: Rash is present in 30% of cases with Chikungunya.

Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

    An Inspirational Story

(Dr Prachi Garg)

Set deadlines

A dream is a goal with a deadline. Without a deadline you won’t achieve most of your goals. Why?

Because there are so many things in life that will take over your time, and before you know it, a year will have gone by and you will be no closer to your goal than you were before.

Set an overall deadline for the completed goal, and also set interim deadlines for each piece that needs to be accomplished.

A deadline must be a specific date, not just sometime before the end of the year, or when you get around to it.

If you miss a deadline, don’t beat yourself up over it, just set a new one and get back to working on the steps to your goal.

    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

A couple has been trying to conceive for past 15 years. The lady is 38 years old and her menstrual cycles are now irregular and scanty. How can we help them?

At the age of 38 with irregular and scanty cycles, reduced ovarian reserve would be the first differential diagnosis. Basic infertility tests like semen analysis should have been done and ensured to be normal. A girl is born to release a fixed number of eggs by the time she reaches menopause which is about, 50 years of age, there are no viable eggs. About 15 years prior to menopause, the lady goes into a transition stage where her ovarian capacity falls drastically. The capacity of women to get pregnant is highest when she is less than 30 years of age. After 35 years, the fall in infertility is exponential. Certain tests like ultrasound, antral follicle count and blood tests like follicle–stimulating hormone and anti–Mullerian hormone will help in the diagnosis. High dose gonadotropin treatment may help this woman. Otherwise ovum donation is a viable option.

    Pediatric Update

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

Complimentary feeding practices between 6 and 24 months

Diversify the diet to improve quality and micronutrient intake.

  • Feed vitamin A–rich fruits and vegetables daily.
  • Feed meat, poultry, or fish daily or as often as possible, if feasible and acceptable.
  • Use fortified foods, such as iodized salt, vitamin A–enriched sugar, iron–enriched flour or other staples, when available.
  • Give vitamin–mineral supplements when animal products and/or fortified foods are not available.
  • Avoid giving drinks with low nutrient value, such as tea, coffee and sugary beverages.


  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/UNICEF, 1998.
  2. Dewey KG. Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/WHO, 2003.
  3. WHO. Complementary Feeding: Family Foods for Breastfed Children. Geneva: World Health Organization, 2000.
    Medicolegal Update

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

What is the vegetative state?

Complete absence of behavioral evidence for self or environmental awareness

  • There is preserved capacity for spontaneous or stimulus–induced arousal, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
  • They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
  • They cannot understand, communicate, speak, or have emotions and unaware of self and environment and have no interaction with voluntarily control passing of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
  • The following behaviors may be seen in the vegetative state:
    • Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; Spontaneous blinking and roving eye movements; Produce sounds but no words; Visual pursuit following an object with her eyes; Grimacing to pain; changing facial expression; Yawning; chewing jaw movements Swallowing of her own spit No purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state observed during the examination.

    Legal Question of the Day

(Dr. M C Gupta)

Q. Are the following two legally on the same footing?

  • An MBBS who gets an MD degree from a foreign university not recognised by the MCI.
  • An MBBS who gets an MD degree after having been allotted the MD seat as a result of counselling after the PG entrance exam conducted by the state government, even though such seat is not recognised by the MCI. (200 PG seats in UP are included for state counselling out of state quota but are not included for All–India level counselling because these are not recognised by the MCI).


  • It is unfortunate that young doctors planning their career are subjected to such unnecessary controversies because of confusion created by the politicians and others.
  • The two are not on the same footing. ‘A’ lacks legal validity. ‘B’ is valid in law.
  • If a student is a registered medical practitioner by virtue of the MBBS degree recognised by the MCI, nobody can legally question his status as a holder of valid MD degree given through a government mechanism simply because the MCI does not recognise the degree. A student cannot be made to suffer because of differences between the state government and the MCI.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Bariatric surgical society takes on new name, new mission and new surgery

Metabolic surgery plays a bigger role in treating type 2 diabetes and other metabolic diseases

Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it is among the most effective treatments for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol, non–alcoholic fatty liver disease and obstructive sleep apnea. Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission or significant improvement of type 2 diabetes and other life–threatening diseases in most patients.

New research indicates that metabolic surgery may improve insulin resistance and secretion by mechanisms independent of weight loss – most likely involving changes in gastrointestinal hormones. Many patients with type 2 diabetes experience complete remission within days of metabolic surgery, long before significant weight comes off. This has led to new thinking that metabolic surgery may also be appropriate for diabetic individuals who are of normal weight or only slightly overweight.

According to a landmark study published in JAMA in 2004, bariatric surgery patients showed improvements in the following metabolic conditions:

  • Type 2 diabetes remission in 76.8% and significantly improved in 86% of patients
  • Hypertension eliminated in 61.7% and significantly improved in 78.5% of patients
  • High cholesterol reduced in more than 70% of patients
  • Sleep apnea was eliminated 85.7% of patients
  • Joint disease, asthma and infertility were also dramatically improved or resolved.

The study showed that surgery patients lost between 62 and 75 percent of excess weight.

Metabolic surgery is the key to battling the twin epidemics of obesity and diabetes, and surgery is becoming safer and safer.

    Head Injury Update

Dr Shameem Ahmed, Dr Atanu Borthakur, Dr Sajida Sultana, Dr Shabbir Khan. Dept. of Trauma and Neurosurgery, Hayat Hospital, Guwahati, Assam.

Prevention of head injury is the best cure

Head injury is by and large preventable. Implementation of adequate legislature such as use of helmet, punishment of traffic violation, stop hit–and–run crime, helmet for pillion rider and bicyclist etc. can actually prevent head injury in the long run. Offences like drink while driving, use of mobile phones, not wearing seat belts, jumping red lights can lead to this life–threatening disaster.

    Mind Teaser

Read this…………………

Land Time

Yesterday’s eQuiz: Which of the following biliary injuries do not present immediately after surgery?
a. Type A
b. Type B
c. Type C
d. Type D

Answer for Yesterday’s eQuiz: b. According to Strasberg's classification of biliary injuries, Type B injury is the one in which there is no bile leak. It is an occlusion of the right sectoral duct.

Correct answers received from: Dr K Raju, Dr Neelam Nath, Dr Swapnil, Dr Anupam

Answer for 7th April Mind teaser: Short notice
Correct answers received from: Dr Vijay Kansal, Dr Nandini Kapoor, Dr (Col) C M Mehta

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Veena Aggarwal)

Letter writing

"I am well here and hope you are also in the same well."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests for celiac disease

  • The best initial laboratory test for diagnosis of celiac disease is anti–tissue transglutaminase antibody (anti–tTG), IgA. If this test is positive, it is likely that the patient has celiac disease.
  • Intestinal biopsy to determine whether there is damage to the intestinal villi.
  • CBC (complete blood count) to look for anemia
  • ESR (erythrocyte sedimentation rate) and CRP (C–Reactive protein) to evaluate inflammation.
  • CMP (complete metabolic panel) to determine electrolyte, protein, and calcium levels and to verify the status of the kidney and liver.
  • Vitamin D, E, and B12 to measure vitamin deficiencies
  • Stool fat, to help evaluate malabsorption.
    Medi Finance Update

(Dr GM Singh)

Q. To what extent can a doctor deposit an amount to PPF?

A. Upto Rs. 70,000 in a financial year.

    Drug Update

List of Approved Drug From 01.01.2010 TO 31.8.2010

Drug Name


DCI Approval Date

Aspirin 75mg + Simvastatin 10mg/20mg + Lisinopril 5mg/10mg + Atenolol 25mg/50mg Tablets

For secondary prevention of coronory heart disease/stroke in patients where use of such combination is appropriate


    IMSA Update

International Medical Science Academy (IMSA) Update

In a retrospective cohort study of otherwise healthy children who had an orbital abscess, proptosis, pain with external ocular movement, and ophthalmoplegia were associated with the presence of an orbital abscess, although 51 percent of patients who had an abscess did not have these findings.

(Dr Vinay Sakhuja)

Latin Quotes

Adeo in teneris consuescere multum est.

Of such importance is to be well trained in youth. (Just as the twig is bent, the tree’s inclined).

  Quote of the Day

(Dr GM Singh)

"In evaluating people, you look for three qualities: integrity, intelligence, and energy. If you don’t have the first, the other two will kill you." Warren Buffett

    Readers Response

Dear Dr Aggarwal, I read your emedinews almost daily…very informative. Congrats for doing all this. Tell me the secret how you get time inspite of your busy schedule, GOD BLESS YOU. Dr RS Talwar.

    Public Forum

(Press Release for use by the newspapers)

Avoid eating cut open fruits & vegetables

Do not eat cut open fruits and vegetables as they can cause typhoid, diarrhea, cholera and jaundice, Dr. KK Aggarwal, Padma Shri & Dr BC Roy National Awardee and President, Heart Care Foundation of India.

Cut open fruits and vegetables, especially watermelon, sold on the streets and sugarcane juice attract flies and other infective organisms. Though banned in the city, they are still available from many hawkers and carry health hazards.

Most food–borne diseases are direct food or water-borne illnesses. Any food stored at room temperature for over two hours is spoiled and may grow organisms. Cut open fruits on the road often remain in this state for hours together. In summer, precautions should also be taken when one is eating cut salad and non covered food in the Tiffin.

The best formula about food hygiene when in doubt is to remember "Heat it, Boil it, Cook it, peel it or forget it." This means that if one is not sure about the food hygiene and/or the offered food cannot be boiled, cooked, heated or peeled (without knife) should not be eaten. Examples are apples, mangoes, salads etc. The best fruits to eat in such situations are bananas and oranges.

Typically, summer infective diarrhea is of small intestine origin and is classically described as watery, effortless, painless and non–bloody loose motions. If the motions are less than 12 per day, they can be easily managed with simple rehydration solution containing sugar, salt, lemon and water. But if more than 12 per day, they require medical observation. If more than 40 per day, they invariably require intensive observation and treatment.

Presence of sugar in the replacement solution works like a drug and is an essential component of any rehydration solution. One can also give coconut water, lemon water with sugar and salt, banana with lemon and salt, rice water with lemon and salt, etc.

Unless a person has vomiting no intravenous drip needs to be given. Normally diet is to be continued both in children and adults. There is no role of antibiotics unless it is a confirmed case of cholera where doxycycline is the drug of choice.

‘Panna’ made out of unripe mango and ‘khus are the traditional drinks, which can be used in this season as refreshing drinks.

    eMedinewS Special

1. eMedinewS audio lectures (This may take a few minutes to open)

2. eMedinewS ebooks (This may take a few minutes to open)

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein
    Situation Vacant

Vacancy for a post of Consultant in Pediatric ICU at Medanta – The Medicity Hospital, Sector –38, Gurgaon.
Interested candidates may please contact: drneelam@yahoo.com/9811043475.
*Eligibility: Post MD/DNB/DCH

    Forthcoming Events

April 16–17, 2011, National Conference on Gynae–Endocrinology–2011 under aegis of FOGSI, ICOG and AOGD, Focus on newer advances in management of endocrinal problems in gynaecology with emphasis on PCOS, hyperprolactinemia, amenorrhoea, hormonal contraception. Gyne– endocrinology is a topic of high importance especially for practitioner. Detailed programme http://www.aiims.edu and http://www.aiims.ac.in
For details please contact: Prof Alka Kriplani, Organizing Chairperson, 9810828717 kriplanialka@gmail.com/Dr Nutan Agarwal, organizing Secretary, 9810107464/9868397310 nutan.agarwal1@gmail.com


May 7–8, 2011, National Seminar On Stress Prevention
A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com


September 30 – October 02, 2011; XVIth World Congress on Cardiology, Echocardiography & Allied Imaging Techniques Venue: The Leela Kempinski, Delhi (NCR), September 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
Highlights of Pre – Conference CME: Case based learning experience & audience interaction, Maximum 250 delegates for CME will be accepted, who will be divided in 5 batches and will rotate to different halls every 90 minutes. The topics are:(A) Right heart pressures & functions (From basics to newer methods (RV anatomy, echo views, echo assessment of RV function, prognostic impact of RV function) (B) Carotid Doppler: How do i assess and interpret in my daily practice.: Technical tips (Anatomy of the vessel, views of ultrasound scanning, Normal & abnormal Doppler hemodynamics, how to measure IMT) (C) Valvular stenosis: Assessment, limitations and their solution: (Anatomy of the valves, 2–D findings of stenotic lesions, quantitation of lesion, limitations) (D) How do I assess and report ventricular dyssynchrony in my lab. (What is ventricular dyssynchrony, what are the types of dyssynchrony, in whom, when & why do we assess it, various echo methods to assess it ) (E) Live 3–D Echo: Protocol for acquisition. How to slice and get full information. Aim is that by end of the day, every participant is well conversant with all the topics
Dr (Col) S.K. Parashar, President, e–mail: drparashar@yahoo.com, Mob:09810146231/Dr Rakesh Gupta, Secretary General, email:jrop2001@yahoo.com, Mob:09811013246
worldcon2011@in.kyoni.com, www.worldcon2011.org


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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 Naveen Dang, Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta