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Dr KK Aggarwal

From the Desk of Editor in Chief
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 October 2010, Saturday

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


Today, Navratras have come to mean simply abstaining from food i.e. food-fast for the nine days. Most of us either do not eat anything or eat only limited food.
Fast does not mean ‘not eating’. Basically a fast means controlling one’s desires and simultaneously cultivating positive mental attitudes. Desires can be of many types viz. desire to eat tasty food, desire to smell, desire to listen to a particular music, desire to watch beautiful things, etc. A ‘fast’ therefore can be of many types. A ‘food-fast’ means controlling the desire for food items which you otherwise may not resist eating. An ‘eye fast’ means not watching things which are rajsic in nature. ‘Ear fast’ means avoiding listening to rajsic (stimulating) music; ‘Action fast’ means not indulging into activities which stimulate and create rajsic thoughts in the mind, and ‘speech fast’ means not speaking any evil, etc.
The first three days of the Navratras, require an individual to perform activities which reduce negativity in the body. The physical purification involves regular bath (of the external body as well as various orifices) and a mental bath, which involves self-confession exercises, and willful attempts to avoid thinking negatively. During these three days, a person tries to restrain himself from thinking, speaking or doing any activity that can harm the other person. The five obstacles to internal happiness are attachment, anger, desire, greed and ego. A person attempts to restrain from all these negativities. These negative thoughts should also not be suppressed or repressed as otherwise they will manifest into some internal diseases.
The next three days, involve building positivity in the mind by various positive mental exercises such as mixing with people, sharing, giving, donating, socializing, reception, etc. Cultivating a thought that is opposite to a negative thought in the mind is the easiest way of tackling negative thoughts. Calling all the people you know during these three days helps in creating social health.
The same principles were taught to us by Mahatma Gandhi as “Do not see evil, do not hear evil and do not speak evil.”
The last three days involve reading and understanding good scriptures and learning from the sins of others. Once you have conquered the negativity in the first three days (representing Kali) and have built up happiness and positivity in the mind (representing Lakshmi), the only thing left is to acquire knowledge (representing Saraswati). During these last three days a person is purified enough to understand and grasp the knowledge of Self and to understand and discriminate between good and bad. One also learns to stay cool irrespective of the face of life being joyful or disturbing. One learns to continue his actions while detaching it with the results.
After the nine days of self-discipline are complete, the person acquires inner happiness, which is nothing but one’s exposure or appointment with the true self or the consciousness. And the birth of consciousness is equivalent to birth of Lord Rama which is called “Ramnavmi”. Hence, Ramnavmi should be celebrated as a disciplined way of acquiring internal happiness and not regarded as a forced nine days of fasting.
Navratras can be interpreted in a similar manner with Dusshera or Vijayadashmi denoting victory over the ego and attaining inner happiness.

Dr KK Aggarwal
Editor in Chief
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  Dengue Update

Cutaneous manifestations of Dengue

  • Cutaneous involvement is seen in 46.8% of patients of dengue.
  • The most common symptom is maculopapular/morbilliform eruption (48.3%), followed by ecchymotic (27.6%), petechial (13.8%), and macular/scarlatiniform (10.3%) eruption.
  • Maculopapular eruption is observed more in Dengue fever (DF)
  • Petechiae, ecchymosis, and mucosal involvement are seen more in Dengue hemorrhagic fever (DHF) 
  • About 72.4% of patients with cutaneous manifestations are asymptomatic; 27.6% have pruritus.
  • A generalized involvement is seen in 48.3% of patients.
  • Limbs and trunk involvement is seen in 32.8% and 18.9% of patients, respectively.
  • Mucosal involvement is seen in 29.8% of patient
  • Conjunctival involvement is most common (20.9%), followed by the lips (4.8%), palate  (2.4%), and tongue (1.6%).

    (Thomas EA, John M, Bhatia A. Int J Dermatol 2007;46(7):715-9).
  Photo Feature (from the HCFI Photo Gallery)

Release of health messages by people who count has been an effective module used by Heart Care foundation of India. During the Perfect Health Mela in 1995, Deepti Naval, Actor released various messages to promote blood donation and AIDS control.

In the photo: Deepti Naval, Dr H K Chopra, Mr Mahesh Khandelwal, Mr Ajay Jaju

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Difficult–to–treat head lice

In a randomized trial, oral ivermectin was superior to malathion 0.5% lotion in patients with head lice who had previously failed therapy with a topical pediculicide.

(Reference: Chosidow O, et al. Oral ivermectin versus malathion lotion for difficult–to–treat head lice. N Engl J Med 2010;362:896)

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

India stops import, manufacture of anti-diabetes drug

The Drug Controller General of India (DCGI) Thursday suspended manufacturing and import of the anti-diabetic drug Rosiglitazone. The US FDA too had recently restricted its use after data suggested continued use of rosiglitazone (Avandia) could increase the risk of cardiovascular problems. European medicine agencies too had withdrawn the drug from the market. In a meeting on Thursday, a committee of eminent doctors decided to suspend further manufacturing of the drug. The expert committee observed that the Indian population was at relatively higher risk of cardiovascular diseases because of multiple factors such as “genetic predisposition, higher incidence of dyslipidemia, higher incidence of metabolic syndrome”. The drug is widely used in India for correcting blood sugar levels. All these factors, the experts said, may lead to more cardiovascular problems with continued use of rosiglitazone.  (Source: The Indian Express)

  International News

(Dr Monica and Brahm Vasudev)

Depression hits one in ten adults

The prevalence of depression among adults in the U.S. stands at 9%, according to a CDC analysis of survey data. This includes 3.4% who have major depression, the agency reported in the Oct. 1 issue of Morbidity and Mortality Weekly Report.

Smog may be linked to diabetes risk

County–by–county data on pollution levels from the Environmental Protection Agency during 2004 and 2005, as well as CDC and US Census information on the prevalence of adult diabetes has shown a strong correlation between adult diabetes and particulate air pollution, a correlation that persists even after adjustment for other risk factors.

Beta blockers good for surgery patients at risk of heart attacks

Doctors could save lives by prescribing cheap beta blockers to surgery patients at risk of heart attacks. The bottom line of a large Veterans Affairs study in the October issue of the journal Anesthesiology is that patients at risk of a heart attack who are undergoing surgery can cut their death risk 35 % by simply taking a drug called a beta–blocker. This new study may allay earlier doubts that beta blockers for surgery patients may pose more harm than good.

Link between retrovirus, chronic fatigue syndrome remains controversial

The journal Science published a study that has linked a retrovirus called XMRV to chronic fatigue syndrome, but several teams, including one led by the CDC and another from the NIH and the FDA, have published papers failing to find such evidence.

  Hepatology Update

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

What are the treatment modalities of neonatal cholestasis?

On suspicion of cholestatic liver disease, vitamin K is started along with supplementation of other fat soluble vitamins (A, D and E). Specific treatment should be started for treatable medical conditions.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is IUI? What is the average success rate of IUI? How many cycles of IUI can we try?

IUI is a simple OPD procedure. In this procedure, washed capacitated sperms are put in the uterus. The ovary is stimulated by giving hormone injections to produce multiple follicles and the procedure is carried out when the eggs are about to be released. We have had a good success rate with this method and recommend it as the first line of treatment in patients who have patent tubes and a reasonably good semen count.

Success rate varies according to the indication but around 15% to 18% can be considered good. Most couples conceive within first three cycles of IUI, in subsequent cycles the positive outcome is less. One can try up to six IUI cycles then probably turn to IVF-ET.

  Eye Update: Question of the Day

What are correct visual habits for children?

  • They should watch TV or read always in the sitting up position, not lying down either on tummy or on the back.
  • They should always view TV or the computer screen directly and not at an angle.
  • They should take breaks every 30–45 minutes for at least 30 seconds to a minute, whenever they use their eyes with concentration such as while reading, watching TV or the computer. By taking a break is meant looking far out into the distance or simply gently shutting their eyes.
  • They should read in a room with adequate light. Generally speaking bulbs are better for the eyes than tube lights. This does not mean that every parent should change the light fixtures in the room. Many children forget to switch on the room lights at dusk, so engrossed are they in their reading. Reading in poor light causes a strain on the eyes. This should be avoided.
  • Whenever the child has extra studying to be done, such as during examinations, it is better to wake up early and read when the eyes are fresh rather than read late into the night, when the eyes are already tired having been strained throughout the day. The old grandmother adage of "early to bed, early to rise" is an excellent advice for kids appearing for exams.
  • Children should avoid reading or playing videogames in moving vehicles, such as cars, trains etc. It is difficult to concentrate on the matter being read or looked at with so many bumps on the road- this causes more strain on the eyes. Reading in an airplane is OK, of course!
  Medicolegal Update

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

What is injury, assault and hurt in medicolegal cases as per Indian penal code?

The words injury, assault and hurt are invariable used by doctors in hospital practice. Though used as synonymous, all these three words have different meaning in law. They are defined by Indian penal code as below:
  • Injury: Section 44 IPC defines injury as any harm whatever illegally caused to any person in body, mind, reputation or property.
  • Assault: Section 351 IPC defines assault as threat or attempt to apply force on the body of another in a hostile manner. It may be a common/simple assault or an intention to murder.
  • Hurt: Section 319 IPC defines hurt as ‘whoever causes bodily pain, disease or infirmity to any person is said to cause hurt.’

As doctors we deal with cases of hurt/body injury mean bodily pain, wound, disease or infirmity voluntarily caused to any person in medico–legal cases. These include abrasion, contusion, laceration, stab wound, electric shock, fire arm or ligatures etc resulting in human body injury.

The doctor who is certifying an injury report should keep in mind the Penal provision which is required by police to book the case means Simple injury – Section 323 of IPC; Simple injury caused by dangerous weapons – Section 324 of IPC; Grievous injury – Section 325 of IPC; Grievous injury caused by dangerous weapons – Section 326 of IPC; Dangerous injury – Section 307 IPC; Injury likely to cause death – Section 304 of IPC; Injury sufficient to cause death – Section 302 IPC and Causing hurt by means of poison – Section 328 of IPC.

  Medi Finance Update

Individual Mediclaim policy

  • Room, boarding, expenses as provided by the hospital/nursing home (restriction of cover on room rent by insurers in majority).
  • Nursing expenses. Surgeons, anesthetist, medical practitioners, consultants, specialists’ fees.
  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

Fixed dose combinations of Vitamins with Analgesics

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Lipid Profile, insist that the lab provides a direct estimated LDL value and not a calculated LDL value for more accurate results.

  IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure had low total cholesterol levels.
Dr Bad: It’s ok.
Dr Good: It’s a matter of concern.
Lesson: Low serum cholesterol in patients with HF is associated with higher mortality. Whether low cholesterol has a causative role or is simply a marker of more severe debilitation (i.e. cardiac cachexia, liver dysfunction, and inadequate nutrition), has not been determined. (J Card Fail 2002;8:216)

Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolides are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

Quote of the Day (Dr. G M Singh)

"When I quote others I do so in order to express my own ideas more clearly." Michel de Montaigne

Ethics and Misconduct

Can a doctor or an institution hire agents for marketing?


  1. Section 7.19 of MCI act “A Physician shall not use touts or agents for procuring patients”.
  2. Section  6.1.1 of MCI Act: “Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical”.
  Mind Teaser

Read this…………………

i i

Answer for yesterday’s Mind Teaser: "Beating around the bush"

Correct answers received from:  Dr.Neena Sablok, Dr Chandresh Jardosh, Dr.R.K.Goel, Dr Sukanta Sen, Dr Kalpana Mohan, Dr Sanjiv Kacker, Dr Neelam Nath, Dr Muthumperumal Thirumalpillai, Dr S. Upadhyaya, Dr.Susheela Gupta, Dr.K.V.Sarma, Dr K.P.Rajalakshmi, Dr. Anita Rajorhia, Dr Virendar Prakash Gautam, Dr Deepti Katyal Uppal, Dr Mohit Joshi, Dr. Aditya Rattan, Dr. Anupam Sethi Malhotra, Dr Anil Manaktala, Dr. Suman Kumar Sinha, Dr.Amritpal Bhatia, Dr. Prashant Bharadwaj  Dr Hiren Shah, Dr.K.Raju, Dr Jainendra Upadhyay, Dr Sudipto Samaddar, Dr Meera Rekhari,  Dr Lakshmi Iyer, Dr Rohini Dhillon

Answer for 7th October Mind Teaser is: "change of plans"

Correct answers received from:Dr Sukanta Sen

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr Chandresh Jardosh)
Definition of a holiday
A holiday is a day a man stops doing what his boss wants and start doing what his wife wants.

You are an Indian if (Anuj Goel)
You talk for an hour at the front door when leaving someone's house.

  An Inspirational Story

Standing for what you believe in, Regardless of the odds against you, and the pressure that tears at your resistance,… means courage.
Keeping a smile on your face, when inside you feel like dying For the sake of supporting others… means strength.
Stopping at nothing, and doing what's in your heart You know is right… means determination.
Doing more than is expected, To make another’s life a little more bearable, Without uttering a single complaint… means compassion.
Helping a friend in need, No matter the time or effort To the best of your ability …means loyalty.
Giving more than you have, and expecting nothing, But nothing in return… means selflessness.
Holding your head high, and being the best you know you can be When life seems to fall apart at your feet, Facing each difficulty with the confidence That time will bring you better tomorrows and never giving up ... means confidence.

  Readers Responses
  1. My best wishes for IMA.....election: Dr Sudhir Gupta
  Public Forum

(Press Release for use by the newspapers)

Unique attractions at the Perfect Health Mela

Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India said that the forthcoming MTNL Perfect Health Mela being organized by Heart Care Foundation of India from 23rd October to 31st October at NDMC Grounds Laxmi Bai Nagar will focus on science behind magic and miracles.

He said that today's science is yesterday's miracle and tomorrow's science is today's miracle.

Both Departments of Science & Technology and Prevention of Food Adulteration Department, Delhi Government will also have a non-stop practical demonstration about food adulteration at the mela venue. With the festival of Diwali approaching, it will be a unique opportunity for the students to come and learn about any adulteration in food items which can be checked at home. Sample wise demonstrations will be held for checking adulteration in milk, khoya, sweets, pulses and spices etc.

  Forthcoming Events

CPLD 2010:Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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