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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

10th January 2013, Thursday

You're a Doctor? How much do you make?

Somebody asked me: "You're a Doctor? How much do you make?" Following was the emotional but correct answer given by my friend Dr Anita Kant and I am reproducing the same as an editorial.

I replied: "HOW MUCH DO I MAKE?"

I can make holding your hand seem like the most important thing in the world when you're scared.

I can make your child breathe when he stops.

I can help your father survive a heart attack.

I can make myself get up at 4 am to make sure your mother has the medicine she needs to live and I will work straight through until 4am to keep her alive and start the day all over again work all day to save the lives of strangers.

I will drop everything and run a code blue for hours trying to keep you alive!!

I make my family wait for dinner until I know your family member is taken care.

I work weekends and holidays and all through the night because people don't just get sick Monday through Saturday and during normal working hours.

Today, I might save your life.

How much do I make?

All I know is that I make a lot of difference.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

    Constipation Update

How is constipation treated?

Stool softeners, suppositories (glycerin or bisacodyl), and enemas, although widely used, have limited clinical efficacy. Glycerin or bisacodyl suppositories can be used in institutionalized older adults with dyssynergic defecation to help with rectal evacuation.

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Lifestyle change can reduce aging

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal In Zee News with Dr Vibha on winter disease.

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

100 seats for MBBS aspirants at AIIMS in Raipur

RAIPUR: With the union health ministry sanctioning an additional 300 MBBS seats for the six newly setup AIIMS like institutes in the country, the availability of seats at Raipur AIIMS would go up to 100 in the coming academic year. This would provide a big opportunity to MBBS aspirants from the region. This was confirmed by the Director AIIMS, Raipur, Dr Nitin Nagarkar, who revealed that besides the MBBS seats, the health ministry had also approved 60 new seats for nursing students in all the new institutes. As of now, 50 MBBS seats are available in each of the new AIIMS at Patna, Bhubaneshwar, Jodhpur, Rishikesh, Raipur and Bhopal. Each of these institutes was allowed to admit 50 students in the first academic year of 2012, as their infrastructure was not complete. From the next academic session, the total number of MBBS seats in the new AIIMS would go up to 600, providing an opportunity to an additional 300 MBBS aspirants. Dr Nagarkar said that construction work at the AIIMS site was in full swing and by the time new session starts, nursing college building and hostel would also be functional. The additional seats would, in a way, help correct the existing imbalance in the availability of public health resources. With these new additions, the overall availability of MBBS seats in India would rise to 42,169 in the next academic year from the existing 41,869 in 335 medical colleges across the country. The health ministry is striving to achieve the target doctor-patient ratio of 1:1000 by 2021, which at present is 1:2000. The government plans to take the overall availability of MBBS seats to 80,000 from the present 41,569 and PG seats to 45,000 from the current 22,194 by 2021. The aim is to tide over the shortage of doctors, which is currently pegged at around 8 lakhs. (Source: TOI, Jan 8, 2013)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

When to intervene in patients with chronic mitral regurgitation?

Symptomatic severe chronic MR

  • EF =30, LVESD =55 mm
  • Primary, NYHA III–IV, severe LVD (EF < 30, LVESD > 55 mm)

Asymptomatic severe chronic severe MR

  • EF 30–60, LVESD =40 mm
  • Watchful waiting: EF 55–60, LVESD 40–45 mm
  • EF > 60, New-onset AF or PAP >50 at rest or >60 with exercise
  • Severe MR, EF >60, LVESD <40 mm (Moderate LAE >50, mild PAH or PAP 30–50)

Watchful waiting

  • Echo every 6 to 12 months or any time symptoms occur.
  • Do not meet the criteria for mitral valve surgery
  • Borderline EF 55–60, LVESD 40 to 45 mm on a single study.
  • Moderate MR may have hemodynamically severe disease.
  • Mild symptoms (NYHA II), and moderate MR, EF >60, LVESD <40, no PAH

Formula: 30–40–50–60
30 (EF >30); 40 (LVESD > 40–45), 50 (LA or PAP >50), 60 (PAP > 60 on ex, EF> 60 with AF)

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Beta-blockers linked to fewer Alzheimer's lesions

The use of beta-blockers for the treatment of hypertension was associated with fewer Alzheimer's-type brain lesions on autopsy than other antihypertensive medications, a new study shows. The study, which is to be presented at the upcoming American Academy of Neurology meeting in March, was conducted by a team led by Lon White, MD, University of Hawaii, Honolulu. (Source: Medscape)

Semantic decision-making corrupted in MCI, AD

Patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) are consistently slower and less accurate than healthy control persons in making semantic decisions in response to stimuli with words and images, new research shows. (Source: Medscape)

Retired athletes at higher risk of brain deficits

Retired football players appear to be at increased risk for experiencing cognitive deficits and depression as they grow older, and for developing abnormalities in brain white matter and blood flow, a small cross-sectional study suggested. (Source: Medpage Today)

GI bleeds: Withholding transfusions boosts survival

Withholding transfusions until hemoglobin levels are lower than 7%, rather than 9%, improves overall survival by 45% in patients with acute upper gastrointestinal (GI) bleeding, according to a study published in the January 3 issue of the New England Journal of Medicine. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Non migraine headache is associated with low levels of serum vitamin D as per results from the sixth survey of the Norwegian Tromsø Study.

@DeepakChopra: If it’s the collective consciousness that is getting played out in the world are we this vindictive & violent? http://tinyurl.com/ans6c8s

    Spiritual Update

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

Win relationships and not arguments

It is a well known saying that when you are arguing with a wrong boss, you may win the argument but you may invariably lose the relationship and not argument. Lord Krishna was born after Lord Rama and Krishna taught us when to say ‘sorry’ even if you are not at fault.

For comments and archives

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

What about miscarriage in the IVF procedure?

According to western figures, the rate of miscarriage may be as low as 15% for women in their 20s to more than 50% for women in their 40s. There is a 2–4% risk of an ectopic, or tubal, pregnancy if an embryo moves from the uterus into the fallopian tube. If an ectopic pregnancy occurs, you will need medication to end the pregnancy or surgery to remove it. If you are pregnant and experience a sharp, stabbing pain, vaginal spotting or bleeding, dizziness or fainting, low back pain or low blood pressure (from blood loss), call your doctor immediately. These are all signs of a possible ectopic pregnancy.

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

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

How is the tissue harvested from a donor?

Tissue is retrieved either through enucleation (whole eye ball removal) or corneal excision. Presently many eye banks in the country retrieve cornea by in situ corneal excision. This procedure involves removing just the cornea from the whole eye of the deceased/donor. During corneal excision, the cornea along with the white part of the eye known as the sclera is excised out. A 2–3mm scleral rim is excised 360 degrees. The procedure takes 20 to 30 minutes. The excised cornea is introduced into a preservative medium, the Mc Carey Kaufman medium (MK medium), which is prepared by the Rotary Club of Hyderabad, Cornea Preservation Center and distributed to all eye banks in the country and South East Asian countries. The MK medium allows preservation of the cornea for a period of 4 days.

For comments and archives

    An Inspirational Story

A little Monkey and Man

Once upon a time, a man was passing through a jungle. He saw a monkey and was attracted to it. He called the monkey and to his surprise, the monkey came near him. The man told the monkey that it was his ancestor and so they should cultivate friendship. With different kinds of gestures, he was able to establish friendship with it.

The man was just trying to kill time using the monkey as company while crossing the jungle. Suddenly unexpectedly, a lion roared fiercely and pounced in front of them. They scarcely had time to escape. The monkey ran and the man followed suit. They found a very huge tree and soon climbed it. Though they were breathless, they did not stop until they climbed to a safe height.

The lion continued to prowl here and there, hoping to catch them when they climbed down. The lion was angry and hungry and awaiting his prey finally sat down under the tree. The man was clinging to one of the strong branches, while the monkey was sitting on a branch with ease, as if nothing had happened. After a prolonged wait, the lion lost patience and proposed to let one of them go scot-free if the other was offered to him as 'food'.

The man and the monkey consulted each other. They even offered to sacrifice their lives for each other, but ultimately concluded that they would live and die together. The lion was disappointed, but not dissuaded. He continued his vigil. Nevertheless, the wait on the tree proved a testing time for both the monkey and the man. They were feeling drowsy. They were both faced with the danger of falling down while dozing on the tree. Ultimately they decided to take turns to sleep.

The monkey would sit wide-awake while the man slept and the man would keep vigil while the monkey had his share of sleep. As decided, it was the man's turn to sleep first, while the monkey kept guard. The monkey slept in the other half of the night, while the man held forth. When the monkey was fast asleep, the man started contemplating. He thought that if he pushed away the sleeping monkey, the lion, as promised, would allow him to go scot-free.

Immediately, he translated his thoughts into action. The monkey was in deep slumber. The man pushed him down. As the monkey was accustomed to such things, he immediately caught hold of the branches halfway and was back to his place in a moment. Without uttering a single word, he went back to sleep as if nothing had happened. In the morning, the monkey led the man to safety. The lion was still on prowl under the tree.

When they reached at the safer place, the monkey made a special request to the man. "Please do not allege that monkeys are ancestors of mankind."

Man without humanity is inferior to animals.

For comments and archives

    Cardiology eMedinewS

Smoking increases MMP gene expression in SVGS, reduces patency following CABG Read More

No increased risk of neurologic complications with transradial PCI
Read More

    Pediatric eMedinewS

Motor skills tied to performance in school Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 30–year–old male with suspected migraine came with runny nose.
Dr. Bad: It cannot be migraine.
Dr. Good: It can be migraine.
Lesson: Migraine can also cause nasal stuffiness and runny nose, or teary eyes in 10–20% of individuals.

Make Sure

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! Why was treatment not started early?
Lesson: Make sure all patients with rheumatoid arthritis are started with specific treatments within 3 months of diagnosis.

  Quote of the Day (Dr GM Singh)

It is better to have loved and lost than never to have loved at all. Alfred Lord Tennyson

    Legal Question of the Day (Dr MC Gupta)

Q. One of the six accused in Delhi gang rape case is reported to be a habitual criminal but is likely to escape jail on grounds of minority simply because our laws have not been amended. What are your comments?

Ans. My comments are as follows:

  1. It is true that a juvenile cannot be put in a jail meant for adults. He will have to be kept in a juvenile home for now. It is true that he will attain majority within a few months. It is true that a person who attains majority cannot remain in a juvenile home. It is true that if a person attains majority during the pendency of trial, he cannot be sent to a jail meant for adults.
  2. The government is reportedly thinking of amending laws in this regard.
  3. However, it must be clearly understood that if a juvenile is a habitual criminal, the real fault is not of the child but of the society that was unable to give a proper environment to the child conducive to normal and happy and desirable development. It is the society which needs to be punished, not the child. The RTE Act should have come half a century ago. Even now it is not being properly implemented. A child who receives good and compulsory schooling till 14 years of age under the RTE Act is unlikely to become a habitual criminal.
    Mind Teaser

Read this…………………

Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:

A. Administer the medication exactly on time
B. Administer the medication with food or mild
C. Evaluate the client’s muscle strength hourly after medication
D. Evaluate the client’s emotional side effects between doses

Yesterday’s Mind Teaser: In ulcerative colitis with toxic megacolon, the lowest rate of recurrence is seen in

a) Complete proctocolectomy and Brook's ileostomy
b) Ileorectal anastomoses
c) Kock's pouch
d) Ileo anal pull-through procedure

Answer for Yesterday’s Mind Teaser: a) Complete proctocolectomy and Brook's ileostomy

Correct answers received from: Dr PC Das, Dr Arpan Gandhi, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Kanta Jain, Dr Avtar Krishan, Dr BK Agarwal.

Answer for 8th January Mind Teaser: C. Maintain the present muscle strength

Correct answers received from: Dr Chandresh Jardosh, Dr BK Agarwal.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

For crying out loud

With all the new technology regarding fertility, an 88-year-old woman was able to give birth to a baby recently. When she was discharged from the hospital and went home, various relatives came to visit.

"May we see the new baby?" one of them asked. "Not yet," said the mother. "I'll make coffee and we can visit for a while first."

Another half hour passed before another relative asked, "May we see the new baby now?"

"No, not yet," said the mother. A while later and again the guests asked, "May we see the baby now?"

"No, not yet," replied the mother.

Growing impatient, they asked, "Well, when can we see the baby?"

"When it cries!" she told them.

"When it cries?" they gasped. "Why do we have to wait until it cries?"

"Because, I forgot where I put it."

    Medicolegal Update

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

What is the right to refuse medical interventions?

Theresa Marie "Terri" Schiavo case of the United States

The consistent refusal to intervene on behalf of Schiavo’s parents’ desire to continue nutrition and hydration is a reaffirmation of the right to refuse medical care even for mentally incapacitated patients and that artificial nutrition and hydration are medical treatments. In theory, the right of patients to refuse medical therapy can be limited by four state interests in: Preservation of life, Prevention of suicide, Protection of third parties such as children and preserving the integrity of the medical profession. In practice, these interests almost never override the right of competent patients and incompetent terminally ill patients who have left explicit advance directives.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Chronological age vs Biological age

The current gangrape has opened a controversy regarding the age of the culprit. If chronological age is taken into consideration, many of the juvenile criminals will escape punishment. One should see the biological age and not the chronological age, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & Vice President-Elect IMA.

You may be 60 (chronological age) but look like 80 (biological age) and you may be 80 (chronological age) but look like a 60-(biological age)-year-old.

Chronological age is simply the current age in years, calculated from the birth date. The biological age is the active rate at which the body is aging. It is a true measurement of the current health, life expectancy and future quality of life. The biological and chronological ages are not necessarily the same.

When we decide the age-linked guidelines for any intervention, we also look at the biological age. The biological age is decided by blood tests, presence or absence of wrinkling, vascular age by echo and carotid ultrasound etc.

    Readers Responses
  1. Justice Verma's recommendation should be explained in detail, taking one point every day, excellent stuff to read. Well done. Vivek Kumar, Varanasi.
    Forthcoming Events
Dr K K Aggarwal

4th eMedinews Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013 (8 AM to 8 PM).

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Eminent Faculty:

Dr Praveen Chandra (Cardiology)
Dr NK Bhatia (Transfusion Medicine)
Dr Ambrish Mithal (Diabetes)
Dr Kaberi Banerjee (Infertility)
Dr Yougal Mishra, Dr Manju Gupta, Dr Somesh Juneja, Dr Deepak Khurana (Valve Surgery)
Dr Rajnish Malhotra (Cardiology)
Dr Vivek Bhatia (GI)
Dr Ashish Jain (Ortho)
Dr Kailash Singla (GI)
Dr IM Chugh (Pulmonoagy)
Dr AK Dhar (Hemato oncology)
Dr Neeraj Jain (Pain Management)

Register at: www.emedinews.in/


Dr Pawan Gupta, Past President IMA Haryana, Organizing Secretary

4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

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

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

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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 Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta