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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

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  Editorial …

11th February 2013, Monday

You can smoke 10 Years of your Life Expectancy

Two studies on smoking and mortality published this week in the New England Journal of Medicine have shown that quitting smoking helped to reduce the risk of death associated with smoking.

One study was led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto, while the other study was led by Michael J. Thun of the American Cancer Society.

Smokers lose at least one decade of life expectancy over nonsmokers on average.

Those who kick the habit before age 40 reduce the excess risk of death associated with continued smoking by about 90%.

Women are now as likely to die from smoking-related illnesses as men. In the early 1960s, women smokers were 2.73 times more likely to die from lung cancer than their nonsmoking counterparts; by 2010, they were 25.66 times more likely to die of the disease.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Primary colorectal dysfunction consists of three overlapping subtypes: slow transit constipation, dyssynergic defecation, and irritable bowel syndrome with constipation. Secondary causes of constipation should be excluded with a thorough history and physical examination followed by diagnostic testing

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

5 of the Best Workouts You Can Ever
Do: Harvard Medical School

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

4th eMedinewS revisited all the medical happenings of the year 2012.

Dr K K Aggarwal
    National News

8,200 children died in 5 years at Safdarjung - Hindustan Times

Lack of essential services, faulty ventilators and unhygienic conditions led to the death of more than 8,200 children at the Safdarjung Hospital in the past five years, an RTI reply from the hospital has revealed. Taking note of a complaint based on the reply, the National Human Rights Commission on Friday issued notices to the secretary, union ministry of health and family welfare, and the medical superintendent of Safdarjung asking them to respond within four weeks.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Physical abuse in children

  1. Physical neglect– Failure to provide adequate food, clothing, shelter, hygiene, protection; inadequate supervision with risk of harm to the child.
  2. Emotional neglect– Failure to provide love, affection, security, and emotional support; failure to provide psychological care when needed; spouse abuse in presence of the child.
  3. Educational neglect– Failure to enroll the child in school or ensure school attendance or home schooling; failure to address specific educational needs.
  4. Medical neglect– Refusal to seek or delay in seeking medical care resulting in damage or risk of damage to the child’s health.

For comments and archives

    Valvular Heart Disease Update

Valvular thickening or sclerosis of the aortic and mitral valve is a frequent occurrence in hemodialysis patients and occur in 55 to 69 percent of individuals.

(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)

Vaginal cleansing with antiseptic improves cesarean outcomes

A review has found that vaginal cleansing with a povidone-iodine solution before caesarean delivery reduces the risk for postoperative endometritis. The antiseptic solution was most beneficial for women whose membranes had ruptured before the caesarean delivery. (Source: Medscape)

Leishmaniasis in skin squashed by novel creams

Two novel topical antibiotic formulations cleared up parasitic skin lesions from the bite of the Tunisian sand fly, a clinical trial showed. (Source: Medpage Today)

Tennis elbow: No long-term benefit from PT, corticosteroids

A steroid injection and 2 months of physical therapy may not be the solution for lateral epicondylalgia, commonly known as tennis elbow, suggest research findings published in the February 5 issue of JAMA. (Source: Medscape)

Antiseptic wipes reduce ICU infections

Infection control in hospital ICUs was improved when patients were washed daily with chlorhexidine-soaked washcloths in a randomized trial, researchers reported. (Source: Medpage Today)

IMS-III: No benefit of endovascular therapy after thrombolysis

Results of the Interventional Management of Stroke III (IMS-III) trial show no benefit of endovascular therapy after the use of intravenous (IV) thrombolysis over IV thrombolysis alone in the treatment of moderate to severe acute ischemic stroke. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: tPA improves outcomes after stroke even in elderly or those with a history of stroke and diabetes. (eMedinewS 2013)

@DrKKAggarwal: Depression Is Still a Mystery - We Need a New Model. Please read my article published by @SFGate http://tinyurl.com/a8gyy7w

    Spiritual Update

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

What are the Rituals For A Pooja?

Pooja means to take care or to serve. As per the Vedas, pooja can be Shodasha Upachara Pooja (16 steps), Dasopachara Pooja (10 steps) or Panchopachara Pooja (5 steps). Most follow the path of 16 steps, which have a deep Vedic meaning.

As God resides within us, we should incorporate these 16 basic steps as the foundation of our daily routine or dincharya. These should also form the steps of our conduct with others and how to receive and treat guest at home (atithi devo bhava).

For comments and archives

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

How do counseling and support groups help those couples who are suffering from infertility?

Infertility at any age is a stressful experience, and counseling or support groups can be helpful. The intrusive nature of infertility testing and treatment can make you feel stressed or out of control. Feelings of sadness, anger, blame, guilt, depression, and loss are normal and can be overwhelming at times. Discussing your concerns with your partner, medical staff, and supportive people in your life is important. It may be helpful to join a support group or see a therapist.

    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)

Myth: Removal of eyes causes disfigurement of the face.
Fact: Removal of eyes does not produce any disfigurement of the face.

For comments and archives

    An Inspirational Story

Be a believer to be an achiever

The professor stood before his class of 30 senior molecular biology students, about to pass out the final exam. 'I have been privileged to be your instructor this semester, and I know how hard you have all worked to prepare for this test. I also know most of you are off to medical school or grad school next fall,' he said to them.

'I am well aware of how much pressure you are under to keep your GPAs up, and because I know you are all capable of understanding this material, I am prepared to offer an automatic 'B' to anyone who would prefer not to take the final.'

The relief was audible as a number of students jumped up to thank the professor and departed from class. The professor looked at the handful of students who remained, and offered again, 'Any other takers? This is your last opportunity.' One more student decided to go.

Seven students remained. The professor closed the door and took attendance. Then he handed out the final exam. There were two sentences typed on the paper: 'Congratulations, you have just received an 'A' in this class. Keep believing in yourself.'

I never had a professor who gave a test like that. It may seem like the easy way out of grading a bunch of exams, but it's a test that any teacher in any discipline could and should give. Students who don't have confidence in what they've learned are 'B' students at best. The same is true for students of real life. The 'A' students are those who believe in what they're doing because they've learned from both successes and failures. They've absorbed life's lessons, whether from formal education or the school of hard knocks, and become better people.

Those are the people who you look for when you're hiring or promoting, and the ones you keep if you're downsizing. Your organization needs their brand of thinking. Psychologists say that by the age of two, 50 percent of what we ever believe about ourselves has been formed; by age six, 60 percent, and at eight years, 80 percent. Wouldn't you love to have the energy and optimism of a little kid? There is nothing you couldn't do or learn or be.

But you're a big kid now, and you realize you have some limits. Don't let the biggest limit be yourself. Take your cue from Sir Edmund Hillary, the first person to reach the summit of Mount Everest: 'It's not the mountain we conquer, but ourselves.' Believing in yourself comes from knowing what you are really capable of doing. When it's your turn to step up to the plate, realize that you won't hit a homerun every time. Baseball superstar Mickey Mantle struck out more than 1,700 times, but it didn't stop him from excelling at baseball. He believed in himself, and he knew his fans believed in him.

Surround yourself with positive people - they know the importance of confidence and will help you keep focused on what you can do instead of what you can't. Who you surround yourself with is who you become. Never stop learning! I would work this advice into every column if I could; it's that important. Don't limit yourself only to work-related classes, either. Learn everything about every subject that you can. When you know what you're talking about, it shows.

Be very careful not to confuse confidence with a big ego. If you want people to believe in you, you also have to believe in them. Understand well that those around you also have much to contribute, and they deserve your support. Without faith in yourself and others, success is impossible.

At the end of a particularly frustrating practice one-day, a football coach dismissed his players by yelling, 'Now all you idiots, go take a shower!' All but one player headed toward the locker room. The coach glared at him and asked why he was still there. 'You told all the idiots to go, Sir,' the player replied, 'and there sure seems to be a lot of them. But I am not an idiot.' Confident? You bet. And smart enough to coach that team some day.

Moral: Believe in yourself, even when no one else does.

For comments and archives

  Cardiology eMedinewS

Tots affected by parents' moods, violence Read More

New TB vaccine not significantly effective Read More

  Pediatric eMedinewS

Tots affected by parents' moods, violence Read More

New TB vaccine not significantly effective Read More

    Rabies Update

(Dr. A. K. Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What is rabies?

Rabies is acute viral encephalitis caused by a RNA virus (Genus: Lyssavirus, Family: Rhabdoviridae). The genus name derives from lyssa, the Greek goddess of frenzy. The virus is bullet shaped and can be seen through an electron microscope only. Rabies is a zoonotic disease (i.e., transmitted by animals) that affects all mammals and is endemic in India.

    IJCP Special

Dr Good Dr Bad

Situation: An adolescent came with pre pubertal gynecomastia of more than six months duration.
Dr Bad: It’s normal.
Dr Good: This is persistent pre pubertal gynecomastia.
Lesson: If the patient is an adolescent and has a normal general physical and genital examination, then it is quite likely that he has pubertal gynecomastia (seen in 25% cases). Re–evaluation at 6–monthly intervals will show whether the condition is persistent or not; improvement supports the initial impression of a pubertal cause.

Make Sure

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure, that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Legal Question of the Day (Dr M C Gupta, Advocate & Medicolegal Consultant)

Q. A complaint has been filed in a consumer court by the patient against a hospital without impleading the Ultrasonologist & Obstetrician even though the main grievance is wrong diagnosis by them. What are your comments?


  1. The filing of such a case shows that the patient has done so without legal advice or with bad legal advice. A good advocate would prefer to include the doctors also among the respondents.
  2. It is open to the hospital to either move an application to implead the doctors in the case or to, even otherwise, produce them as witnesses, in person or through affidavits, to prove non-negligence.
  3. If there is negligence, the general principle is that damages are awarded against the hospital and not against the doctors who work for the hospital. This is so irrespective of the fact that doctors are a party in the case. If they have not been made a party in the case, the question of award of damages against them does not arise.
  4. The following may be quoted in this connection:

    The SC held as follows in Savita Garg (Smt.) vs. Director, National Heart Institute – (2004) 8 S.C.C. 56.—(Quoted by NC in Varadha S. Nair v. Dr. Remani.)

    “, a similar view was expressed with regard to burden of proof in Savita Garg (Smt.) vs. Director, National Heart Institute – (2004) 8 S.C.C. 56. The Apex Court observed that:

    “Once a patient is admitted in a hospital it is the responsibility of the hospital to provide the best service and if it does not, then the hospital cannot take shelter under the technical ground that the surgeon concerned or the nursing staff, as the case may be, was not impleaded, and therefore, the claim should be rejected on the basis of non-joinder of necessary parties. In fact, once a claim petition is filed and the claimant has successfully discharged the initial burden that the hospital was negligent, and that as a result of such negligence the patient died, then in that case the burden lies on the hospital and the doctor concerned who treated that patient, that there was no negligence involved in the treatment. Since the burden is on the hospital, they can discharge the same by producing that doctor who treated the patient in defence to substantiate their allegation that there was no negligence. In fact it is the hospital which engages the treating doctor thereafter it is their responsibility. The burden is greater on the institution/hospital than that on the claimant. The institution is a private body and they are responsible to provide efficient service and if in discharge of their efficient service there are a couple of weak links which have caused damage to the patient then it is the hospital which is to justify the same and it is not possible for the claimant to implead all of them as parties.” (emphasized supplied)”.
  Quote of the Day (Dr GM Singh)

It is wise to direct your anger towards problems – not people; to focus your energies on answers – not excuses. William Ward

    Mind Teaser

Read this…………………

On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops:

A. Intolerance to heat
B. Dry skin and fatigue
C. Progressive weight gain
D. Insomnia and excitability

Yesterday’s Mind Teaser: Stroke volume of the heart is determined by:

a. The degree of cardiac muscle strength (precontraction)
b. The intrinsic contractility of the cardiac muscle
c. The pressure gradient against which the muscle ejects blood during contraction
d. All of the above factors

Answer for Yesterday’s  Mind Teaser: c. The pressure gradient against which the muscle ejects blood during contraction

Correct answers received from: Dr Jayashree Sen, Dr Shashi Saini, Dr Thakor Hitendrsinh G, Dr PC Das, Rajiv Kohli, Dr Suresh Arora, Dr Kanta Jain, Dr (Maj. Gen.) Anil Bairaria, Arpan Gandhi,

Answer for 9th February Mind Teaser: b. increased levels of circulating catecholamines

Correct answers received from: Dr KV Sarma, Dr N P Mishra, Dr Sushil Kumar

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr.Chandresh Jardosh)

Top Secret Communications Center

When my son was in the Air Force, my wife and I visited quite often. On our first visit, we were allowed inside this top secret Communications Center, but everything in sight was covered up so we could look around everywhere -- Heck, even the toilet paper in the Men's room was disguised.

Anyway, at the exit, there's a sign above the door, which reads: “You have been exposed to Top Secret Material. Please destroy yourself before leaving the building.”

    Medicolegal Update

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


Supreme Court of Georgia echoed the Illinois decision, albeit with somewhat different wording

  • Every person who enters into a learned profession undertakes to bring to the exercise of his profession a reasonable degree of care and skill. He does not undertake to use the highest possible degree of skill, for there may be persons who, for having enjoyed a better education and greater advantages, are possessed of greater skill in their profession; but he undertakes that he will bring a fair, reasonable, and competent degree of skill…He is not responsible for an error in judgment…if such error arises from the peculiar circumstance of the case, and not from the want of proper care or competent skill on his part.
  • Nearly a half–century later, a state of New York appeals court issued an opinion as to what constitutes the standard of care of a medical physician. Although the lawsuit did not involve radiology, the court decision could have well applied to radiologic interpretation
  • The law requires a physician to possess the skill and learning which is possessed by the average member of the medical profession…and to apply that skill and learning with ordinary reasonable care. He is not liable for a mere error in judgment, provided he does what he thinks is best after a careful examination. He does not guarantee a good result.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

H1N1 flu shots safe for pregnant women

An NIH study of pregnant women in Norway has shown that those who were infected with the 2009 H1N1 influenza virus had an increased risk of miscarriages and stillbirths. But those vaccinated against the virus had no increased risk of pregnancy loss.

Influenza viruses have two surface proteins—hemagglutinin (H) and neuraminidase (N)—that allow them to enter and spread from cell to cell.

The study by Dr. Siri Haberg, at the Norwegian Institute of Public Health and colleagues examined data from over 117,000 pregnancies and reported the findings in January 24, 2013, in the New England Journal of Medicine. Fifty-four percent of pregnant women in their second or third trimester were vaccinated during the pandemic. Vaccination substantially reduced the risk of an influenza diagnosis—by about 70 percent. The results showed that influenza infection almost doubled the risk of fetal loss. Influenza vaccination, however, didn’t increase the risk of fetal loss.

In India, H1N1 is an important cause of flu, said Padma Shri and Dr B C Roy National Awardee and National Vice President Elect IMA, Dr KK Aggarwal The vaccinations protect pregnant women against influenza illness, which could be harmful for both the mother and the baby and hence should be considered by the doctors for pregnant ladies.

    Readers Response
  1. Dear Sir, emedinews is really very informative. Regards: Dr TP Mishra
    Forthcoming Events


Sri Aurobindo Ashram – Delhi Branch will organize the 6th Study Camp on ‘Mind-Body Medicine and Beyond’ for doctors, medical students and other health professionals at its Nainital Centre (Van Nivas) from June 8-14, 2013. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind-body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of the Mind-Body Medicine Clinic at AIIMS, and the author of Back to Health through Yoga, Eating Wisely and Well and Essays on Yoga. For more details, send an e-mail to the Ashram (aurobindo@vsnl.com) or to Dr. Bijlani (rambij@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)

4. eMedinewS ebooks (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, Dr Usha K Baveja