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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


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  Editorial …

10th September 2011, Saturday

New Delhi metallo–beta–lactamase (NDM–1)

Enterobacteriaceae isolates carrying a novel MBL gene, the New Delhi metallo–beta–lactamase (NDM–1) was first described in December 2009 in India with Klebsiella pneumoniae (1). Later, it was described in patients who had traveled to and undergone procedures in India and Pakistan (2). Cases were also reported in Asia, Europe, and North America (2-4). Isolates have also included E. coli and Enterobacter cloacae (2).

Risk factors

  1. Recent treatment with carbapenem
  2. Indwelling urinary or venous catheters
  3. Severe illness (5)
  4. NDM–1 can inactivate all beta–lactams except aztreonam.

Salient points

  1. It is an important emerging resistant pathogen (6).
  2. NDM1 isolates are susceptible to colistin or tigecycline
  3. The susceptibility is short–lived.
  4. NDM–1 has been identified in public water supplies in India (7)


  1. Yong D, Toleman MA, Giske CG, et al. Characterization of a new metallo–beta–lactamase gene, bla (NDM–1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046.
  2. Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597.
  3. Centers for Disease Control and Prevention (CDC). Detection of Enterobacteriaceae isolates carrying metallo–beta–lactamase – United States, 2010. MMWR Morb Mortal Wkly Rep 2010;59:750.
  4. Sidjabat H, Nimmo GR, Walsh TR, et al. Carbapenem resistance in Klebsiella pneumoniae due to the New Delhi Metallo–β–lactamase. Clin Infect Dis 2011;52:481.
  5. Deshpande P, Shetty A, Kapadia F, et al. New Delhi metallo 1: have carbapenems met their doom? Clin Infect Dis 2010;51:1222.
  6. Nordmann P, Poirel L, Toleman MA, Walsh TR. Does broad–spectrum (beta)–lactam resistance due to NDM-1 herald the end of the antibiotic era for treatment of infections caused by Gram–negative bacteria? J Antimicrob Chemother 2011;66:689.
  7. Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM–1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis 2011;11:355.

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

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

New Delhi metallo–beta–lactamase (NDM–1)

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Student presenting a beautiful step in the Harmony – Interschool Health Festival at 17th MTNL Perfect Health Mela 2010.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Fast–tracking organ donation

NEW DELHI: In a crucial ruling that will fast–track the process of organ transplant for needy patients, the Delhi high court has cleared an ambiguity in the laws governing transplant. Justice Rajiv Sahai Endlaw, in a judgment delivered last week but released on Tuesday, said the power to verify organ donors/receivers lies only with the authorities of the place where the intended transplant is to be performed. Till now, donors/receivers are subjected to multiple scrutinies – a donor has to first convince his native state authorities, then present himself before the state from which the organ receiver hails, often leading to interminable delays that often prove fatal for the patient. (Source: TOI, Sep 7, 2011)

For comments and archives

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

(Dr Monica and Brahm Vasudev)

Neurostimulation gets CE mark approval for chronic migraine

An implantable neurostimulation device to treat the pain and disability caused by intractable chronic migraine headaches has been granted a CE Mark of approval for use in Europe. The Genesis neurostimulation system, developed by St. Jude Medical, in Plano, Texas, is the first device of its kind to win CE mark approval and it is the first regulatory approval for the device for the treatment of chronic migraines. The US Food and Drug Administration (FDA) approved the Genesis neurostimulation system in 2001 for spinal cord stimulation in chronic back pain associated with failed back surgeries, as well as chronic limb and trunk pain. (Source: Medscape Medical News)

For comments and archives

African ancestry linked to peanut allergies

Black children are more likely to be sensitized to food allergens than are white children, according to the results of a cohort study reported online September 5 and will appear in the October print issue of Pediatrics. (Source: Medscape Medical News)

For Comments and archives

Weight watchers works, randomized trial shows

Overweight patients in a Weight Watchers program succeeded in losing weight and improving disease risk factors such as blood lipids and insulin sensitivity relative to standard care in an international trial. After one year, those randomized to the program lost an average of 5.06 kg (11.1 lbs), compared with an average loss of 2.25 kg (5.0 lb) with standard care, reported Susan A. Jebb, PhD, of the U.K. Medical Research Council’s Human Nutrition Research division in Cambridge, England, and colleagues online in The Lancet. (Source: Medpage Today)

For comments and archives

  Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Potatoes can reduce blood pressure

Just a couple of servings of potato a day can reduce blood pressure in obese or overweight people with high blood pressure, calling into question the lowly spud's current reputation as a fattening, unhealthy food, according to new research presented at a conference in Denver, Colorado, USA, on Wednesday. "The potato, more than perhaps any other vegetable, has an undeserved bad reputation that has led many health–conscious people to ban them from their diet," said Dr Joe Vinson, a professor in the Department of Chemistry at the University of Scranton in Pennsylvania, who led the research that was presented at the 242nd National Meeting & Exposition of the American Chemical Society (ACS).

But before you go out and order French fries, the preferred way of eating this most consumed of all vegetables in the US, consider this: the research was done with purple potatoes cooked in the microwave oven, with no oil or fat whatsoever. Vinson said when you mention "potato" what generally comes to mind is "fattening, high–carbs, empty calories". But that is because of the way this humble vegetable is usually prepared. "In reality, when prepared without frying and served without butter, margarine or sour cream, one potato has only 110 calories and dozens of healthful phytochemicals and vitamins," said Vinson, adding that he and his colleagues hope their study will help to remake the potato's popular nutritional image.

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Eco Fest – An Inter School Eco Club’s Health Festival This year the theme for the festival will be Science Behind Rituals

@DeepakChopra: #CosmicConsciousness We make the universe visible and tangible

    Dr KK Answers

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

How serious is ventilator–associated tracheobronchitis?

#DrKKAnswers: Ventilator–associated tracheobronchitis VAT has the same clinical implications as ventilator–associated pneumonia (VAP). An observational study of 28 patients with VAT and 83 patients with VAP showed that VAT groups had a similar length of intensive care unit stay, length of hospital stay, duration of mechanical ventilation, survival rate to discharge, need for tracheostomy, and need for antibiotics.

For comments and archives

    Spiritual Update

Cardiac Revival in Vedic Times: Savitri Satyavan

Vedas describes three aspects of consciousness or life, the Senses (in mythology depicted by Gayatri); the Prana or the life force (depicted by Savitri) and the Speech or Vak (depicted by Saraswati). The three also represent purity in thought, word, and deed (thrikarana shuddhi).

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Admitting Flaws

In the mid–1980’s researchers at Cleveland State University made a startling discovery. They conducted an experiment by creating two fictitious job candidates David and John. The candidates had identical resumes and letters of reference. The only difference was that John’s letter included the sentence "Sometimes, John can be difficult to get along with". They showed the resumes to a number of personnel directors. Which candidate did the personnel directors overwhelmingly prefer? Difficult to get along with, John.

The researchers concluded the criticism of John made praise of John more believable. Admitting John’s wart actually helped sell John. Admitting flaws gives you more credibility. A key to selling.

For comments and archives

    Gastro Update

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

What is the significance of ANCA and ASCA antibodies?

Perinuclear anti–neutrophil cytoplasmic(ANCA) antibody is positively associated with UC and anti–Saccharomyces cerevisiae (ASCA) antibody with CD, but the diagnostic sensitivity of these serological markers only ranges between 60% and 80%, so they are of limited clinical use.

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

Under the aegis on AOGD

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

Day – 1 Interesting Highlights

Panel Discussion 1 – Obstetric Outcome in ART Pregnancies

This interesting panel discussion will cover all aspects relevant to ART pregnancies. This would include miscarriages, multiple pregnancies, congenital malformations, fetal reductions and pre term deliveries.

Panelists: Anita Kaul, New Delhi, Sudarshan Ghosh Dastidar, Kolkata, Nandita Dimri, New Delhi, Ashutosh Gupta, New Delhi, Jaishree Sundar, New Delhi, Kiran Guleria, New Delhi
Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan – e– Hindustan – Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Please Contact: E –23 Ayurvigyan Nagar New Delhi – 110049

For details contact +91 9871250235

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


The ammonia test is primarily used to help investigate the cause of changes in behavior and consciousness. It may be ordered, along with other tests such as glucose, electrolytes, and kidney and liver function tests, to help diagnose the cause of a coma of unknown origin or to help support the diagnosis of Reye’s syndrome or hepatic encephalopathy caused by various liver diseases. An ammonia level may also be ordered to help detect and evaluate the severity of a urea cycle defect.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with painful diabetic neuropathy came with postural hypotension.
Dr Bad: The two are unrelated conditions.
Dr Good: It is due to autonomic dysfunction.
Lesson: Painful diabetic neuropathy is associated with significantly greater autonomic dysfunction than painless diabetic neuropathy. The greater autonomic dysfunction seen in painful diabetic peripheral neuropathy (DPN) may reflect more predominant small fiber involvement and also adds to the growing evidence of its role in the pathophysiology of painful DPN (Diabetes Care 2010;33(7):1585–90).

For comments and archives

Make Sure

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn’t you observe the IV site carefully?
Lesson: Make sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, as extravasation of calcium can produce severe interstitial necrosis.

For comments and archives

  Quote of the Day

(Dr Chandresh Jardosh)

Action may not always bring happiness, but there is not happiness without action.


Gut feeling: A personal intuition you get, especially when you feel something may not be right.

  Rabies Update

(Dr A K Gupta, Author of "RABIES – the worst death".)

What are the symptoms of rabies in human beings?

Hydrophobia is the best known clinical feature of rabies and is typically unique to human beings. Hydrophobia is due to a violent jerky contraction of the diaphragm and the accessory muscles of inspiration that is triggered by the patient’s attempt to swallow liquid.
The incubation period of the virus, that is the time interval between the bite and the onset of hydrophobia, is usually from 3 weeks to 3 months (rarely 04 days to 02 years).

Prodromal syndrome (Lasts for 2–10 days)

  • Pain at the site of bite in association with fever, malaise, nausea and vomiting.
  • The skin is sensitive to changes of temperature, especially air currents. About 10 days later, the CNS stage begins.

Neurologic stage (Lasts for 2–7 days)

  • Aphasia
  • Incoordination
  • Paresis
  • Paralysis
  • Mental status changes
  • Hyperactivity

Late symptoms

  • Hypotension
  • Coma
  • Disseminated intravascular coagulation (DIC)
  • Cardiac arrhythmias
  • Cardiac arrest
  • Fatality

For comments and archives

    Medicolegal Update

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

Keep chemicals safely, Use it safely and get rid of left–over chemicals and empty containers

It is important to handle all chemicals safely, not just the ones that you know are poisons. Many chemicals that you might not think are poisonous could make someone ill or cause burns. It is very important to protect children, because they cannot protect themselves and they do not understand that some things can be poisonous. Many poisonings could be prevented if chemicals were kept safely, used safely and got rid of safely.

  • Do keep medicines, cleaners and pesticides where children cannot see or reach them.
  • Do not keep chemicals you no longer need.
  • Do not put chemicals in containers that once contained food or drink; people may eat or drink the chemicals by mistake.
  • Do use medicines, cleaners, pesticides and other chemicals in the right way, and use the right amount neither more nor less. Read the label and follow carefully the instructions for use. A person who cannot read it should find someone who can. It may be dangerous to use chemicals from unlabeled containers. Ask the supplier for another container with a label.
  • Do find out whether it is better to bury or burn the chemicals you want to get rid of. Choose a place to bury or burn chemical waste where there will be as little danger as possible to the people living nearby or to the environment.
  • Do find out from environmental health officers or community leaders the local arrangements for getting rid of chemical waste. Seek professional advice about how to get rid of large amounts of unwanted chemicals.
  • Do not use empty bottles, cans or other containers that have been used for storing chemicals to store or cook food or drink. Do not give them to children to play with.
  • Do not leave left–over chemicals or empty containers where children might find them.
  • Do not throw left–over chemicals or empty containers near a river, pond or spring. Chemicals might get into the water and poison fish, or poison people or animals that drink the water or wash in it. This may also happen if chemical waste is poured into drains that empty into waterways.

For comments and archives

    Mind Teaser

Read this…………………

The femoral ring is bounded by the following structures except:

1. Femoral vein
2. Inguinal ligament
3. Femoral artery
4. Lacunar ligament

Yesterday’s Mind Teaser: Surgical Treatment of bleeding type I gastric ulcer is

a) Wedge resection of the gastric ulcer
b) Oversewing the vessel at the ulcer base
c) Distal gastrectomy
d) Distal gastrectomy along with truncal vagotomy

Answer for Yesterday’s Mind Teaser: c) Distal gastrectomy

Correct answers received from: Dr Ragavan Moudgalya, Dr Sri San, Dr Shikha Jain, Dr Chandresh Jardosh, Dr Jainendra Upadhyay.

Answer for 8th September Mind Teaser: 4. Contains postganglionic parasympathetic fibers.
Correct answers received from:Dr K Raju, Dr Jainendra Upadhyay.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. Chandresh Jardosh)

Why are wives more dangerous than the Mafia?

The mafia wants either your money or life… The wives want both!

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name


DCI Approval Date

Paracetamol 325mg + Tramadol Hydrochloride 37.5 mg Tablets

Additional indication. (For symptomatic treatment of moderate to severe pain.)


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Eco Fest – School Eco Club’s Festival at MTNL Perfect Health Mela

18th EcoFest, a School Eco Club’s Festival will be organized on Thursday, 20th October, 2011 at MTNL Perfect Health Mela to be held at NDMC Grounds Laxmibai Nagar, New Delhi. Over 3000 school children from Delhi/NCR will be participating in the event.

The festival will be organized by Heart Care Foundation of India, Department of Health, Government of Delhi, NDMC, MCD and World Fellowship of Religions.

Giving the details, Padmashri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President of Heart Care Foundation of India and MTNL Perfect Health Mela said that keeping the environment clean can prevent a large number of communicable diseases. Environment hygiene includes air hygiene, water hygiene and food hygiene. Various competitions on these subjects will help the children in bringing out their creativity and coming out with innovative ways of tackling environmental problems in the society.

This year the theme for the festival will be Science behind Rituals and the competitions will include – Slogan writing, painting, collage making, quiz, poster making etc.

For comments and archives

    Readers Response
  1. Dear Sir, the spiritiual update column of yesterday "Thanks Krishan for not started smoking: Dr K K" was very touchy and gives a healthy message. Regards: Dr Anupama
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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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