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  From the Desk of Editor–in–Chief
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 May 2011, Monday                                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

Char Dhaam Yatra: Preventing acute mountain sickness

  1. Slow ascent is the best prevention.
  2. If one lives below 5,000 feet (1,500 m), one should avoid ascending rapidly. On the first night, avoid sleeping above 9,000 feet (2,800 m).
  3. Between 5000–10,000 feet have a night halt.
  4. If one is planning to travel above 9,800 feet (3,000 meters) one should not ascend more than 1,600 feet (500 meters) per day.
  5. One should take a full day rest for every 3,200 feet (1,000 meters) ascent.
  6. On rest day one should not ascend higher or over–exert.
  7. For better adjustment one should climb high and sleep low. One should hike to a higher altitude during the day and return to a lower elevation to sleep at night.
  8. One should not over–exert during the first few days at altitude.
  9. One should not consume alcohol and sleeping pills, especially in the first two days.
  10. If one stays at elevations above 4,900 feet (1,500 meters) in the weeks before one ascends may allow one to ascend faster.
  11. If one drinks caffeine (coffee, tea, soda) regularly, he or she should not stop drinking it before or during the trip. Caffeine is safe at high altitudes, and stopping it suddenly can cause symptoms similar to AMS (Acute mountain sickness).
  12. One should be more careful if he or she has had acute mountain illness or another high altitude illness previously.
  13. Preventive drugs are given if one has had high altitude illness previously or wants to ascend quickly.
  14. The drug is acetazolamide to be started a day before the ascent and to be continued for 48 hours or until one reaches the highest point of the trip.
  15. Acetazolamide can temporarily cause carbonated drinks to taste unpleasant.
  16. Other side effects can include the need to urinate more frequently, numbness or tingling in the hands or feet, nausea, drowsiness, or blurry vision.
  17. Acetazolamide is not recommended for pregnant women.
  18. Acetazolamide is a sulfa medicine, but many people with a sulfa allergy can take acetazolamide without a problem.
  19. Dexamethasone is a steroid that may be recommended as a preventive treatment if one is allergic to acetazolamide.
  20. Taking aspirin or ibuprofen can help to prevent the headache that often occurs with AMS.
  21. If one intends to ascend quickly, one can start taking aspirin or ibuprofen before the ascent or take on developing headache.
  22. If one had high altitude pulmonary edema in last visit or wants to ascend quickly to altitudes above 8,200 feet (2,500 meters), one may also take nifedipine (commonly used to treat high blood pressure), dexamethasone, or acetazolamide to prevent lung swelling.

Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Evidence which has changed practice in last one year

Meningococcal vaccination

In late 2010, the Advisory Committee on Immunization Practices (ACIP) recommendations for meningococcal vaccination were modified to recommend that adolescents be vaccinated ideally at age 11 or 12, with a booster at age 16. In addition, a two–dose primary series two months apart was recommended in individuals with persistent complement component deficiency or functional or anatomic asplenia, as well as for adolescents with HIV infection.

  eMedinewS Audio PostCard

Diabetes Update

Dr Vinod Sanghi Speaks on
‘The UKPDS Trial’

Audio PostCard
    Photo Feature

World Earth Day 2011 observed

Padma Shri and Dr BC Roy awardee Dr KK Aggarwal, President Heart Care Foundation of India taking a look at the drawings done by students of DPS, Mathura Road

Dr K K Aggarwal
    National News

Mixed stem cell cure creates history

KOLKATA: Five–year–old Moinam Pal, an e–beta thalassaemia patient, walked into medical history on Friday as the first Indian patient to be cured by mixed stem cell therapy. The unique method of treatment that combines stem cells taken from cord blood as well as bone marrow works better than cord blood and bone marrow stem cell therapies administered in isolation. Moinam received stem cells from his two–year–old sister Ahona’s cord blood on April 3 and was released on Friday from the Netaji Subhas Cancer Research Institute (NCRI) after a month of intense therapy. The youngster is stated to be on the path of recovery. Carried out in three phases, the stem cell transplantation commenced with the destruction of Moinam’s existing bone marrow cells. "We used conditioning chemotherapy for that and then stem cells from his sister, extracted from her cord blood and bone marrow, were injected into him. It was done in a highly–steralized chamber but required no surgery. Tests reveal that Moinam’s blood group has started changing from AB+ to B+, while female chromosomes have already appeared in his bone marrow which suggest he is well on the way to recovery and would soon be cured of thalassaemia," said Ashish Mukhopadhyay, director NCRI who conducted the procedure.

Stem cells in the cord blood are not sufficient to wipe out thalassaemia. Often, the cell count in cord blood is not high enough. The result is a partial cure. Bone marrow stem cells, on the other hand, often lead to a Graft Versus Host Disease ( GVHD) which is triggered by the body’s defense mechanism while the transfusion is being done. "Taken together, the two therapies can complement each other and lead to a complete cure. In this case, the signs are there to suggest that the procedure has been successful," explained Mukhopadhyay. (Source: TOI, May 7, 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)

Fit Facts and Tips – Women During Pregnancy and the Postpartum Period

  • Healthy women who are not already highly active or doing vigorous–intensity activity should get at least 150 minutes of moderate–intensity aerobic activity a week during pregnancy and the postpartum period. Preferably, this activity should be spread throughout the week.
  • Pregnant women who habitually engage in vigorous–intensity aerobic activity or who are highly active can continue physical activity during pregnancy and the postpartum period, provided that they remain healthy and discuss with their health–care provider how and when activity should be adjusted over time.

(Dr Monica and Brahm Vasudev)

Surgery shows survival benefit in early prostate Ca

Younger men with early–stage prostate cancer had a significantly lower mortality risk with radical prostatectomy compared with watchful waiting, long–term follow–up from a Scandinavian study showed. Surgery was associated with almost a 50% reduction in the relative risk of prostate cancer death at 15 years among men younger than 65 with low–risk disease, as reported in the May 5 issue of the New England Journal of Medicine. All–cause mortality was about 40% lower.

FDA okays Everolimus for rare pancreatic tumors

The FDA has approved everolimus (Afinitor), the first new treatment in 30 years for advanced pancreatic neuroendocrine tumors (pNET) that cannot be removed by surgery or that have spread to other parts of the body.

Staying up late at night may lead to weight gain

According to a study published online May 4 in the journal Obesity, staying up late at night can lead to an additional two pounds a month weight gain.

Stress may predict development of impaired glucose metabolism in normoglycemic individuals

Perceived stress and stressful life events predict the development of impaired glucose metabolism (IGM) over five years in previously normoglycemic individuals, according to results from the Australian Diabetes, Obesity, and Lifestyle study (AusDiab).

    Spiritual Update

Hanuman Chalisa

Vidyavaan Guni Ati Chatur
Ram Kaj Karibe Ko Atur

Meaning: You have the greatest wealth of divine knowledge. You are virtuous and intelligent, always ready to serve Lord Rama.
Spiritual Significance: By doing regular Pranayama and acquiring the powers of Hanumana one achieves the greatest wealth of knowledge about the self. It increases one’s intelligence with readiness to serve others all the time.

    IJCP Special

Dr Good Dr Bad

Situation: One whole family came for typhoid vaccination.
Dr Bad: Bring your family tomorrow for vaccination.
Dr Good: Also bring your servants and food handlers at home for vaccination.
Lesson: It is not only important to vaccinate your family members but equally important to simultaneously vaccinate the workers at your home, especially the food handlers to break the cycle.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

    An Inspirational Story

(Dr Prachi Garg)

The man who went to Heaven and who was able to compare

A man died and because he had been a good person, he went to Heaven, where Saint Peter greeted him at the door. Welcome! he said. You can enter Heaven right away, but, because you lived such a good life, you can also go and check out Hell first, if you like.

The man was rather curious and said – well, why not – and he went down all the stairs to reach the door of Hell, which opened before him. Behind the door, he saw many people sitting around tables with delicious food! But they were all very sad, and suffering, because instead of hands they had long knives and forks as arm extensions and they did not manage to put any of this great food in their mouths.

The man went back up to Heaven and said to Saint Peter: Wow, am I glad that I can go to Heaven. That is really some punishment. Welcome to Heaven, Saint Peter said, as he let the man in.

What did he see there? He saw many people sitting around tables with delicious food, just like in Hell!

And just like in Hell, they also had these long fork and knive extensions on their arms! But in Heaven, the people weren’t crying or cursing, because they were sticking the food in each other’s mouths! "Try this", they laughed. "And this!", and they had lots of fun in the process.

Lesson: Happiness comes from making other people happy. Don’t be selfish but care for other people, and you will be taken care of as well.

    Pediatric Update

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

Fasting blood sugar

Even mild elevations in fasting blood sugar values during childhood predict a risk for developing type 2 diabetes mellitus. In the Bogalusa heart study, children with fasting blood sugar values in the upper half of the normal range (between 86 and 99 mg/dL (4.8 to 5.5 mmol/L) have 2.1 times the risk for developing diabetes during adulthood, and 3.4 times the risk for developing pre–diabetes, independent of the child’s weight status (Arch Pediatr Adolesc Med 2010;164:124).

    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

Atrophic Vaginitis

A 55–year–old woman, an executive, comes in with complaints of itching of vagina and on being interrogated tells that there is increasing vaginal dryness and that sex is painful. She is about 3 years post menopausal and although she has begun systemic HRT and continues to use it, she still has complaints of vaginal dryness and pain with intercourse. Her other medical history is essentially negative and she was (previously) determined to be a good candidate for systemic therapy. When you evaluate her today she is still a good candidate for systemic therapy.

Concern: Atrophic vaginitis is in epidemic proportions. About 80% of postmenopausal women are symptomatic and about 20% present with atrophic vaginitis symptoms; of those, about 1% to 5% will seek specific treatment for atrophic vaginitis symptoms. Many will seek treatment at a relatively advanced age, about 5 to 10 years after menopause. The reason is an age–related increase in the severity of symptoms –– less than 5% among premenopausal women, going up to about 25% of women by 1 year after menopause, and to 50% by years 3 to 5.

Patients would rarely come out about sexuality problem themselves; you have to bring out this problem by talking tactfully. You have to talk like "We are interested in taking care of you as a complete person, understanding all of the issues that are going on, not only with your physical health, but also your emotional health and your intimate health is also important as well."

    Medicolegal Update

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

Doctor must record dying declaration in terminally injured patient

Under section S.32 of Indian Evidence Act a written or oral statement of an injured/sick dying person is called dying declaration, it must be recorded by the doctor attending an injured/sick person/patient who is dying/under medical expectation of death as a result of some unlawful act, relating to the material facts of cause of his death or bearing on the circumstances The dying declaration/statement carries legal importance to identify the offender or to clear innocent persons

  • If there is time the doctor should call the area Magistrate to record the statement/declaration., the doctor should certify that the person is conscious and his mental faculties are normal at the time of recording the statement. If the victim is very serious, and there is no time to call a Magistrate, the doctor should take the declaration in the presence of two witnesses particularly any attendant of other admitted patient. As far as possible, choosing nurses and paramedics as witness should be avoided to maintain the legal credibility of declaration. While recording the dying declaration, oath is not administered, because of the belief that the dying person tells the truth. The statement should be recorded in the man’s own words, without any alteration of terms or phrases. Leading questions should not be put.
  • The declarant should be permitted to give his statement without any undue influence, outside prompting or assistance. If a point is not clear, question may be asked to make it clear, but the actual question and the answer received should be recorded. It should then be read over to the declarant, and his signature or thumb impression is taken.
  • The statement made must be of fact and not opinion. If the declaration is made in the form of an opinion or conclusion, questions should be asked by the recorder to bring out the facts that are the basis for the conclusion. While recording the statement, if the declarant becomes unconscious, the doctor recording it must record as much information as he has obtained and sign it. If the dying person is unable to speak, but is able to make signs in answer to questions put to him his can be recorded and it is considered as a "verbal statement".
  • The doctor and the witness should also sign the declaration. If the statement is written by the declarant himself, it should be signed by him, the doctor and the witnesses. The declaration is admissible not only against an accused that killed the declarant, but also against all other persons involved in the same incident which resulted in his death.
  • The declaration is sent to the Magistrate in a sealed cover. It is produced at the trial and accepted as evidence in case of death of the victim in all criminal and civil cases, where the cause of death is under enquiry. The person recording the declaration will have to give evidence in the Court of law under oath to prove it. If the declarant survives, the declaration is not admitted but has corroborative value, and the person is called to give oral evidence under oath.
  • In India, if the declarant is in a sound state of mind at the time of making the declaration, it is admissible in Court as evidence, even if the declarant was not under expectation of death at that time.
    Twitter of the Day

@DrKKAggarwal:Menshould take about 30 grams of fiber a day, and women about 25 gram.

@DeepakChopra:Awareness of our mortality makes every moment precious so the purpose of life can become the expansion.

    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Life after Bariatric surgery

Post operative (Stage 3)

About five weeks after surgery, one can begin to add solid food to diet. A low fat diet eaten in small amounts (½ cup –3/4 cup) should be the basic principle. Remember to chew your food well.

This would be a low fat diet which will provide 1000–1200 kcal and 50–60 grams of protein.

    Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: ONCE 4:56pm

Answer for Yesterday’s Mind Teaser: once upon a time

Correct answers received from: Dr.K.V.Sarma, Dr. Anupam Sethi Malhotra, Dr. Manjesha, Dr U Gaur, Dr.K.Raju, Dr Y J Vasavada.

Answer for 7th May Mind Teaser: Eskimos live at the North pole, penguins at the South pole.
Correct answers received from: Dr. V M Kartha, Dr. B. B. Aggarwal, Dr U Gaur, Dr Kamal J Manjesh.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr. GM Singh)

Wise decision

Five people were cruising and enjoying, suddenly a storm came and the boat they were sailing started sinking. All of them were shocked and thinking the way to escape. One person asked the rest: "Is there any one who knows the prayers to save life on this occasion?". "Sure, I know that prayers", one person replied. "Thank God! We had only 4 life jackets", they all suggested.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tumor marker tests

Tumor markers are chemicals made by tumor cells that can be detected in blood. But, they are also produced by some normal cells in the body and levels may be significantly raised in noncancerous conditions, which limit its diagnostic use. Examples of tumor markers: Prostate–specific antigen (PSA) for prostate cancer; cancer antigen 125 (CA 125) for ovarian cancer; calcitonin for medullary thyroid cancer; alpha–fetoprotein (AFP) for liver cancer and human chorionic gonadotropin (HCG) for germ cell tumors, such as testicular cancer and ovarian cancer.

    Medi Finance Update

(Dr GM Singh)

Financial update

Remember when you are thinking of insuring yourself, it should purely mean protecting your life against any contingent events; and thus given that you should be ideally buying only pure term life insurance plans, which gives due importance to your human life value. It is noteworthy that ULIPs are investment–cum–insurance plans where for the premium paid, the insurance cover offered under these plans is far less (usually 10 times your annual premium) when compared to pure term life insurance plans; where for a lesser premium amount you get a greater life cover – which precisely what a life insurance plan is intended for.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Metoprolol succinate ER 25mg + 50mg + Olmesartan 20/20mg
For the treatment of essential hypertension
    IMSA Update

International Medical Science Academy (IMSA) Update

Prostate cancer

Analyses from randomized trials of PSA screening have shown that PSA velocity adds little or no independent prognostic information to PSA alone.

    Quote of the Day

(Dr GM Singh)

The height of your accomplishments will equal the depth of your convictions. William F. Scolavino

    Readers Responses

I read Dr. Mani’s views about diagnostic value of Mantoux test in TB. I differ in opinion, as this test has established diagnostic value only in Pediatric TB. Tuberculin sensitivity is a function of host immunity–delayed hypersensitivity–T–lymphocytes. Positive tuberculin reaction means only immune reactivity due to exposure to M. tuberculosis antigens–tuberculization, clinically tubercular infection. Degree/intensity/dimension of positive tuberculin reaction has no correlation with presence, activity, mycobacterial load of tubercular disease. So negative Mantoux cannot exclude TB infection or disease (immunosupression situation) and a strongly positive/ulcerated reaction is not TB disease/active TB/severe TB! A positive Mantoux >10mm below 5years of age is suggestive of tubercular infection and indicates further workup for presence of tubercular disease – the current consensus view. Dr. Pramod M. Kulkarni.

    Public Forum

(Press Release for use by the newspapers)

Anger recall is as bad as Anger itself

Conducting a workshop on Stress Prevention, on the second day, Padma Shri and Dr BC Roy Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India said that even recall of anger is dangerous.

Anger recall causes sympathetic over activity. The resulting increased adrenaline and noradrenaline levels lead to plaque rupture and consequently a heart attack or myocardial infarction (MI).

Anger recall is as bad as anger itself, which can be expressive or suppressive. Both are dangerous. Expressive anger causes plaque to rupture leading to heart attack or MI, while suppressive anger causes chronic sympathetic overactivity that helps plaque formation.

The answer is anger management and not expression nor suppression of anger. Those people who get angry and are heart patients should not miss their aspirin dose as aspirin takes away the bad effects of anger.

The workshop was held as part of the two–day National Seminar on Stress Prevention–Workshop–cum–seminar on Stress Management and Prevention of Lifestyle Disorders held at Om Shanti Retreat Centre, near Manesar.

Others who spoke at the workshop included BK Shanti, BK Sapna and BK Brij Mohan from Om Shanti Retreat Centre.

    eMedinewS Special

1. eMedinewS audio PPT (This may take a few minutes to download)

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

3. 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

  How to Use

  Pesticides Safely

  Towards Well Being

    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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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 Parveen Bhatia, ( bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar ( http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta