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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

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  Editorial …

11th March 2013, Monday

Multivitamins and cancer

Observational studies have not shown a consistent decrease in cancer risk with multivitamin use.

  • A large randomized trial of multivitamins, involving over 14,000 men has demonstrated a small, statistically-significant reduction in total cancer risk in the multivitamin group (1). The study included male physicians 50 years and older at recruitment. At a mean follow-up of 11.2 years, there was a reduction in total cancer from 18.3 to 17.0 events per 1000 person-years but there was no impact on cancer mortality.
  • In the past a systematic review of 38 studies found that neither vitamin C nor vitamin E supplementation was beneficial for prevention of cancers (2).
  • A 2006 NIH consensus concluded that "present evidence is insufficient to recommend either for or against the use of multivitamin supplements by the American public to prevent chronic disease" (3).
  • A long-term randomized trial in women found no evidence that supplementation with vitamin C, E, or beta-carotene decreased cancer incidence or mortality (4).
  • Two long term observational studies found no association between multivitamin use and risk of cancer. (5,6)

Currently it has not been established that multivitamin and mineral supplements provide added benefit to a balanced, healthful diet for most individuals.


  1. Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA 2012;308:1871.
  2. Coulter ID, Hardy ML, Morton SC, et al. Antioxidants vitamin C and vitamin e for the prevention and treatment of cancer. J Gen Intern Med 2006;21:735.
  3. NIH State-of-the-Science Panel. National Institutes of Health State-of-the-science conference statement: multivitamin/mineral supplements and chronic disease prevention. Ann Intern Med 2006; 145:364.
  4. Lin J, Cook NR, Albert C, et al. Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial. J Natl Cancer Inst 2009;101:14.
  5. Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts. Arch Intern Med 2009;169:294.
  6. Park SY, Murphy SP, Wilkens LR, et al. Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study. Am J Epidemiol 2011;173:906.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

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    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, was organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions.

Dr K K Aggarwal
    National News

Indian families spending less on health, education

NEW DELHI: Indian households are allocating less of their spending to education and healthcare and more to travel and eating out than they did in the past, the latest GDP data reveals. Expenses towards education and medical care have, in fact, been declining since 2008-09, according to the data, along with a decline in spending on food. Expenditure towards medical care and health services has declined from 3.9% of the total private consumption expenditure in 2010-11 to 3.7% in 2011-12. In 2004-05, the sector constituted 5% of total expenditure. Similarly, educational expense has remained constant in 2011-12 and 2010-11 at 1.3%, down from 1.4% in 2009-10. In 2004-05, expenses towards education stood at 1.7% of total consumption expenditure. In food, the percentage expenditure fell from 30.1% in 2010-11 to 29% in 2011-12. Sectors such as clothing and footwear showed a decline in overall consumption expenditure for the first time in a decade. Private consumption expenditure in sectors such as transport and communication, hotels and restaurants, however, has registered an increase. Contribution of hotels and restaurants towards overall consumption expenses increased from 2.3% in 2010-11 to 2.6% in 2011-12. Expenditure towards purchase of transport services too increased from 8.1% to 8.3% in 2011-12.

For most experts, a decline in spending towards these sectors has come as a surprise, even as a fall in spending towards food was expected. "It is a puzzle. Expenses towards health and education tends to go up, although not as fast as in sectors such as durables," said Pronab Sen, chairman of the National Statistical Commission. While there has been a significant increase in public sector education schemes such as the Sarva Shiksha Abhiyan, this should not have been a reason for a decline in expenses towards private education, he added. Increased spending towards discretionary items is another factor which has led to a consequential decline in the proportion spent towards necessities, analysts said. While overall consumer expenses have increased, the rise in expense towards education and health sectors has not been parallel. "Both of these (education and health) should have gone up. It is very odd. But the overarching trend has been that spending towards necessities is going down. People are able to exercise more choice now," said D K Joshi, chief economist at Crisil. Analysts said expenses towards education and medical care and health services as a percentage of the total consumption expenditure will only continue to decline. "In health, in rural areas and tier I and tier II towns, a lot of cases are not reported and a large part of the sector is unorganized. Spending in education too is unlikely to grow faster than overall expenses. Despite a rise in cost of education, only a small section of the people are shifting from moderate level to high level of education," said Madan Sabnavis, chief economist, CARE ratings. (Source: TOI, Mar 9, 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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Educational neglect – Failure to enroll the child in school or ensure school attendance or home schooling; failure to address specific educational needs.

For comments and archives

    Valvular Heart Disease Update

How is the severity of MR defined?

  • Mild MR: RV <30 ml/beat, regurgitant fraction (RF) <30%, effective regurgitant orifice (ERO) <0.2 cm
  • Moderate MR: RV 30–59 ml/beat, RF 30–49%, EROA 0.2–0.39 cm
  • Severe MR: RV =60 ml/beat, RF =50 percent, and EROA =0.4 cm, respectively

(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)

CDC says be on alert for new coronavirus

The number of confirmed cases of the novel coronavirus hCoV-EMC has risen to 14, but none has been reported in the U.S., according to the CDC. Still, the agency is urging doctors with patients who have an unexplained respiratory illness and recent travel to the Arabian peninsula or neighboring countries to report the cases to the CDC. (Source: Medpage Today)

Menactra vaccine seems safe for pregnant women

A review of vaccine event reports suggests pregnant women can safely receive the meningococcal vaccine Menactra (Sanofi Pasteur), according to researchers at the Centers for Disease Control and Prevention in Atlanta, Georgia. (Source: Medscape)

Vision loss carries depression risk

More than one out of every 10 U.S. adults who report vision loss has clinically meaningful symptoms of major depression, a large cross-sectional study found. (Source: Medpage Today)

Leptin helpful in non-alcoholic steatohepatitis

Recombinant human methionyl leptin (metreleptin) appears highly effective for non-alcoholic steatohepatitis (NASH) in lipodystrophy patients with hypoleptinemia, a new paper says. (Source: Medscape)

Systematic care helps urban poor control BP

A telemedicine system -- using phone or Internet to transmit data twice a week -- was no better at lowering high blood pressure in urban patients than regular in-office care, but both methods can achieve results, researchers found. (Source: Medpage Today)

  Twitter of the Day

@DrKKAggarwal: Bitter facts about drugs 1. The margin for medicines is 30-40%. If a doctor (cont) http://tl.gd/l82r9u

@DrKKAggarwal: Keys to self-power = Immune to criticism, beneath no one, fearless.

    Spiritual Update

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

Understanding the concept of Shiva and Shakti

After the life force leaves the body even the wife does not likes to come near the body (Bhaja Govindam). This life force has no weight, water cannot wet it, air cannot dry it, and weapons cannot cut it (Bhagwat Gita Chapter 2).

For comments and archives

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

Smoking cessation as a treatment issue in couples undergoing fertility therapy

Cessation of smoking for at least two months before attempting IVF significantly improves chances for conception. Although long–term cigarette smoking can have an irreversible effect on ovarian function, the harmful effect on treatment outcome may, in part, be reversed if smoking is discontinued prior to entering into fertility therapy.

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

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

How is blood formed?

Blood consists of RBCs, WBCs and platelets suspended in plasma. In early embryonic life, blood cells are formed in liver and spleen. But by the 5th month, hemopoiesis (i.e., formation of blood) occurs in bone marrow and lymphatic tissues. At birth, the entire bone marrow is red and active. Gradually as the child grows, only the marrow in the flat bones and vertebrae remains red. The RBCs, granulocytes of WBCs and platelets are mainly produced by bone marrow. The lymphocytes, monocytes, plasma cells are formed in the lymphoid and reticuloendothelial tissues. The orderly proliferation of the cells in the bone marrow and their release into circulation is carefully regulated according to the needs of body. Everyday new blood cells are being produced in the bone marrow and every day old cells are dying and are being removed from the body.

Red blood cells have life of 120 days i.e. any red cell formed in the body will live for the next 120 days and when it becomes old and senile it is thrown out. White cells live for a couple of weeks and platelets for a few days.

For comments and archives

    An Inspirational Story

The wooden bowl

A frail old man went to live with his son, daughter-in-law, and a four-year old grandson. The old man’s hands trembled, his eyesight was blurred, and his step faltered.

The family ate together nightly at the dinner table. But the elderly grandfather’s shaky hands and failing sight made eating rather difficult. Peas rolled off his spoon onto the floor. When he grasped the glass often milk spilled on the tablecloth.

The son and daughter-in-law became irritated with the mess. “We must do something about grandfather,” said the son. I’ve had enough of his spilled milk, noisy eating, and food on the floor. So the husband and wife set a small table in the corner. There, grandfather ate alone while the rest of the family enjoyed dinner at the dinner table. Since grandfather had broken a dish or two, his food was served in a wooden bowl. Sometimes when the family glanced in grandfather’s direction, he had a tear in his eye as he ate alone. Still, the only words the couple had for him were sharp admonitions when he dropped a fork or spilled food. The four-year-old watched it all in silence.

One evening before supper, the father noticed his son playing with wood scraps on the floor. He asked the child sweetly, “What are you making?” Just as sweetly, the boy responded, “Oh, I am making the bowl for you and mama to eat.” The four-year-old smiled and went back to work. The words so struck the parents that they were speechless. Then tears started to stream down their cheeks. Though no word was spoken, both knew what must be done. That evening the husband took grandfather’s hand and gently led him back to the family table. For the remainder of his days he ate every meal with the family. And for some reason, neither husband nor wife seemed to care any longer when a fork was dropped, milk spilled, or the tablecloth soiled.

Children are remarkably perceptive. Their eyes ever observe, their ears ever listen, and their minds ever process the messages they absorb. If they see us patiently provide a happy home atmosphere for family members, they will imitate that attitude for the rest of their lives. The wise parent realizes that every day those building blocks are being laid for the child’s future. Let us all be wise builders and role models. Take care of yourself, and those you love, today, and every day!

For comments and archives

  Cardiology eMedinewS

Diagnosing gestational diabetes a 2-step process, says panel Read More

Selenium supplements 'not justified' for CVD prevention Read More

  Pediatric eMedinewS

C. difficile infection in children may be on the rise Read More

FDA panel recommends 2013-2014 flu vaccine strains 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 are the most common modes of exposures of rabies virus?

Human exposures to rabies can generally be categorized as bite, open wound, mucous membrane, or other types of exposure:

  • Bite exposure: Any penetration of the skin of a person by the teeth of a rabid or potentially rabid animal.
  • Open wound exposure: Introduction of saliva or other potentially infectious material (cerebrospinal fluid, spinal cord, or brain tissue) from a rabid or potentially rabid animal into an open wound (e.g., broken skin that bled within the past 24 hours).
  • Mucous membrane exposure: Introduction of saliva or other potentially infectious material (cerebrospinal fluid, spinal cord, or brain tissue) from a rabid or potentially rabid animal onto any mucous membrane (eyes, nose, mouth).
  • Other exposure: Any interaction with a rabid or potentially rabid animal where a bite, open wound, or mucous membrane exposure cannot be definitively ruled out.
    IJCP Special

Dr Good Dr Bad

Situation: A patient with normal LDL and high CRP wanted to know his risk of CAD.
Dr Bad: You are not at risk.
Dr Good: Get cardiac 64 CT test done.
Lesson: Among asymptomatic individuals with normal LDL cholesterol levels and elevated high–sensitivity C–reactive protein measuring the burden of calcium in the coronary arteries with cardiac CT appears to stratify the risk of cardiovascular disease (Ref: Blaha M, et al. Associations between C–reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population–based cohort study. Lancet 2011;378:684–92).

Make Sure

Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

  Quote of the Day (Dr GM Singh)

Temper is a weapon that we hold by the blade. James Matthew Barrie

    Mind Teaser

Read this…………………

A 78-year-old man is scheduled for discharge after treatment for heart disease. His wife, who has chronic obstructive pulmonary disease, plans to care for him at home. She says that their grown children who live nearby will help. The best approach to discharge planning is to:

a. Arrange nursing home placement for the couple.
b. Consult the wife's health care practitioner about the wife's ability to care for her husband.
c. Contact the children to ascertain if they will definitely help.
d. Discuss community resources with the wife and offer to make referrals

Yesterday’s Mind Teaser: Which is an accurate statement about the administration of acetaminophen (Tylenol) to children?

a. Acetaminophen (Tylenol) affects platelet aggregation.
b. Acetaminophen (Tylenol) causes gastric irritation.
c. Acetaminophen (Tylenol) does not have an analgesic ceiling.
d. Acetaminophen (Tylenol) has an analgesic ceiling.

Answer for Yesterday’s  Mind Teaser: Acetaminophen (Tylenol) has an analgesic ceiling.

Correct answers received from: Dr Thakor Hitendrsinh G, Dr PC Das, Dr Avtar Krishan, Dr (Maj. Gen.) Anil Bairaria, Dr Bharat Bhushan Aggarwal, Dr Arpan Gandhi, Dr KV Sarma, Dr Kanta Jain, Dr Jayashree Sen & Dr Bitaan Sen

Answer for 9th March Mind Teaser: b. The client keeps the drainage bag below the bladder at all times.

Correct answers received from: Dr Jainendra Upadhyay, Dr Chandresh Jardosh

Send your answer to ijcp12@gmail.com

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

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    Laugh a While (Dr GM Singh)

After a Bad Accident

Patient: I'm in a hospital! Why am I in here?
Doctor: You've had an accident involving a train.
Patient: What happened?
Doctor: Well, I've got some good news and some bad news. Which would you like to hear first?
Patient: Well... The bad news first...
Doctor: Your legs were injured so badly that we had to amputate both of them.
Patient: That's terrible! What's the good news?
Doctor: There's a guy in the next ward who made a very good offer on your slippers.

    Medicolegal Update

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

Reconstitution of the body following an autopsy

An important component of the autopsy is the reconstitution of the body such that it can be viewed as normal following the autopsy procedure.

  • After the conduction of postmortem examination, the body has an open and empty chest cavity with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck. All organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation.
  • Normally the internal body cavity is lined with cotton wool or an appropriate material; the organs are then placed into a plastic bag to prevent leakage and returned to the body cavity. The chest flaps are then closed and sewn back together and the skull cap is sewed back in place.
  • The cases of mutilation/dismembered corpse must be surgically repaired into a normal anatomical position.
  • Then the body must be properly sutured and reconstructed by the doctor conducting the autopsy with a cosmetic and parlor touch and then only it should be handed over to the relative of deceased as a regard of human corpse for ritual cremation

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Chickenpox: anti viral drugs can prevent complications

March is the season for chicken pox. Primary infection with varicella virus causes chickenpox in susceptible hosts. It can cause significant complications, such as soft tissue infection, pneumonia, hepatitis and encephalitis in adults, pregnant women and immunosuppressed hosts. All adults and older children should receive anti viral drugs said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and National Vice President Elect IMA.

Treatment Guidelines

  • Anti allergy drugs can be given for pruritus.
  • Fingernails should be closely cropped to avoid significant excoriation and secondary bacterial infection.
  • Paracetamol should be used to treat fever, particularly in children, since the administration of aspirin has been associated with the onset of Reye syndrome.
  • Acyclovir, an antiviral drug (not a trade name) is an effective therapy for primary varicella in both healthy and immunosuppressed hosts.
  • Acyclovir is safe and effective for varicella if given during the first 24 hours of rash.
  • Acyclovir should be given to all older children and adults (older than 12 years of age), secondary household cases, history of chronic cutaneous or cardiopulmonary disorders, on steroids, on chronic salicylates.


  • Varicella vaccination is recommended for all children between 12 and 15 months of age without evidence of immunity.
  • Routine second dose of varicella vaccine at age four to six years.
  • All susceptible children aged 19 months to 13 years should be fully vaccinated (with two doses) by their 13th birthday.
  • Routine vaccination for all healthy persons aged >13 years is recommended for those without evidence of immunity.
  • Two doses of single-antigen varicella vaccine should be given 4 to 8 weeks apart.
  • Varicella vaccine is highly recommended in VZV-seronegative adults with ongoing risk of exposure (e.g., day care employees), those who are household contacts of immunosuppressed hosts and in women of child-bearing age.
  • A second dose of varicella vaccine is recommended for adolescents and adults who had previously received only one dose.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 30438 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

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