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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

  Editorial …

11th May 2011, Wednesday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Consensus document advises treating hypertension in those age 80 or older

Major medical organizations last week released an expert consensus document to manage older patients with or at risk for hypertension. While 64% of men and 78% of women older than age 80 years have high blood pressure, only one in three men and one in four women have adequate control of their blood pressure. (http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.01.008)

Results from the Hypertension in the Very Elderly Trial (HYVET) in 2008 showed clear benefits for using antihypertensive therapy in people age 80 years and older, including a 30% reduction in stroke, 23% reduction in cardiac death, 64% reduction in heart failure and 21% reduction in all–cause mortality.

  1. Targeting blood pressure less than 140/90 mm Hg in persons age 65 to 79 years and a maximum systolic blood pressure between 140 and 145 mm Hg in persons 80 years and older (if tolerated)
  2. ACE inhibitors, beta–blockers, AR blockers, diuretics and calcium–channel blockers are all effective in lowering blood pressure and reducing cardiovascular events among the elderly. The choice between drugs should be based on efficacy, tolerability, comorbidities and cost.
  3. Antihypertensive drugs should generally be started at the lowest dose, then increased in gradual increments as tolerated. If the first drug reaches its maximum dose, then a second should be added—a diuretic if it wasn’t the first drug. If the antihypertensive response is inadequate after reaching full doses of two classes of drugs, a third drug from another class should be added.
  4. When blood pressure is more than 20/10 mm Hg above goal, therapy should be initiated with two antihypertensive drugs.
  5. One should check blood pressure measures in the standing position also.
  6. Lifestyle changes may be all that are needed for milder hypertension. (physical activity, restriction of salt, weight control, smoking cessation and avoidance of excessive alcohol intake–more than two drinks for men and one drink for women daily).

Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Resource which has changed practice in last one year

Dabigatran for patients with atrial fibrillation

In patients with atrial fibrillation for whom anticoagulant therapy is chosen, start dabigatran rather than warfarin

    eMedinewS Audio PostCard

CKD Update

Dr KK Aggarwal Speaks on
‘Baseline evaluation’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

National Seminar On Stress Prevention

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal delivering a lecture on stress management during the 2–day National Workshop–cum–seminar on Stress Management and Prevention of Lifestyle Disorders held at Om Shanti Retreat Centre, near Manesar.

Dr K K Aggarwal
    National News

All India security helpline soon for passengers on moving trains

Ministry of Railways is working on a three digit all India security helpline for passengers on moving trains. This would be quite similar to the police helpline (100) available in many Indian cities. "If things go according to our plan, we would be able to roll out the all India helpline in a year from now. There are certain issues and the department is working overtime to address them," a senior official with the ministry said on Saturday. The networking of all RPF units and its security control room has already started. The idea behind the project is to provide passengers with a platform through which they could inform security personnel about crime and other such activities on moving train. It was found that in many cases there was delay in the information about crime on moving trains reaching to the Railway Protection Force (RPF). (Source: The Pioneer, May 09, 2011)

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

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

World’s largest exercise class gets kids active around the globe

In conjunction with May as Exercise is Medicine® Month, "The World’s Largest Exercise Class" is coming to children and schools around the world. Project ACES (All Children Exercise Simultaneously) engages millions of children, parents and teachers each year to participate in physical activity at their schools and homes. Through Project ACES, children learn the value and importance of good nutrition, adequate physical fitness and healthy decision–making – lessons they can carry well into adulthood.

(Dr Monica and Brahm Vasudev)

Cath lab has role in treatment of heart defects

Cardiac catheterization, used predominantly as a diagnostic method, should be added to the toolbox for treating heart defects in children, according to the American Heart Association. The AHA offered a laundry list of 22 catheter–based treatment scenarios that should be considered for pediatric heart defects in a statement appearing online in Circulation: Journal of the American Heart Association.

Rising asthma prevalence baffles experts

The proportion of Americans with asthma rose by almost a full percentage point, to 8.2%, from 2001 to 2009, according to the CDC, despite improved outdoor air quality and reduced indoor exposures to tobacco smoke. Moreover, rates among African–American children were more than double the national average and increased faster than for other groups, CDC researchers reported online in Mortality and Morbidity Weekly Report. (Medpage Today)

Salt study discounts link to hypertension

In a study that seems likely to re–energize the debate over dietary salt, European researchers found that the changes in the amount of sodium excreted in the urine were related to changes in systolic blood pressure. But they were not linked to diastolic pressure or the risk of developing hypertension, according to Jan Staessen, MD, PhD, of the University of Leuven in Leuven, Belgium, and colleagues. And levels of urinary sodium excretion were inversely related to the risk of dying of cardiovascular causes, Staessen and colleagues reported in the May 4 issue of the Journal of the American Medical Association. Taken together, Staessen and colleagues argued, the findings do not support "the current recommendations of a generalized and indiscriminate reduction of salt intake at the population level." (Medpage Today)

    Spiritual Update

Hanuman Chalisa

Sukshma Roop Dhari Siyahi Dikhwana
Vikat Roop Dhari Lank Jarawa

Meaning: You appeared before Sita in a very small form, but you burned Lanka with a terrifying form

Spiritual Significance: With advanced Sidhi Pranayama using hypnotic exercise, when one is in a state of ritam bhara pragya, one can experience lightness and heaviness at will. In a relaxed parasympathetic state of mind, the body becomes suggestive to the mind. One can fly, become lighter or heavy, make their body size smaller or larger (it’s all in the feelings of the person meditating and not physical). Ritam stage is the stage where the micrcosm and the macrocosm are in a state of union and harmony.

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with community-acquired pneumonia.
Dr Good: Start 500 mg levofloxacin daily.
Dr Bad: Start azithromycin 500 mg daily.
Lesson: Several large randomized treatment trials of community-acquired pneumonia have compared fluoroquinolone therapy to treatment with beta–lactams with or without a macrolide. In each study, clinical response was equivalent or superior in patients in the fluoroquinolone treatment group. (Clin Ther 2002;24:1915)

Make Sure

Situation: A patient with acute fever developed acute bleeding after aspirin was given.
Reaction: Oh my God! Why was dengue not ruled out?
Lesson: Make sure that all patients with acute febrile illness are evaluated for dengue as low platelets count can precipitate bleeding in these, if aspirin is given to reduce fever.

    An Inspirational Story

(Dr Anupam Sethi Malhotra)


A wonderful story comes from 19th century England. According to the account, Queen Victoria was once at a diplomatic reception in London. The guest of honor was an African chieftain. All went well during the meal until, at the end, finger bowls were served. The guest of honor had never seen a British finger bowl, and no one had thought to brief him beforehand about its purpose. So he took the bowl in his two hands, lifted it to his mouth, and drank its contents down!

For an instant there was breathless silence among the British privilege guests, and then they began to whisper to one another. All that stopped; however, when Queen Victoria silently took her finger bowl in her two hands, lifted it, and drank its contents! A moment later, 500 surprised British ladies and gentlemen simultaneously drank the contents of their own finger bowls.

It was the queen’s uncommon courtesy that guarded her guest from certain embarrassment.

Success Principles

"Knowledge, ability, experience are of little avail in reaching high success if courtesy be lacking, "Courtesy is the one passport that will be accepted without question in every land, in every office, in every home, in every heart in the world. For nothing commends itself so well as kindles; and courtesy is kindness."

    Pediatric Update

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

What is acute liver failure?

Acute liver failure is defined as severe functional impairment of hepatocytes with no pre–existing liver disease, with coagulopathy not corrected by vitamin K.

  • INR >1.5 + encephalopathy
  • INR >2 ± encephalopathy
    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

How can we evaluate the female recipient?

Routine medical and reproductive history should be checked for the women anticipating pregnancy. Abnormalities may require more detailed evaluation and treatment before proceeding with insemination.

A general physical examination includes a pelvic examination. Recommended tests include blood group and Rh factor, HIV1 & 2, Rubella, Hepatitis B surface antigen, Hepatitis C antibody, VDRL.

    Medicolegal Update

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

Resuscitation injuries in postmortem

Soft tissues injuries, nail marks, various contusions, rib fractures are common in both adults and children who have undergone cardiopulmonary resuscitation. However, potentially life–threatening injuries occur very rarely.

  • The doctors performing resuscitation go through a very exhaustive cycle of CPR and generally forget to put a note after resuscitation particularly if resuscitation is followed by death. Hence a format contents of resuscitation detail should be kept attached to clinical sheet by the doctors.
  • The pre–arrest history in a resuscitated adult often assists the doctor conducting the autopsy to interpret findings related with resuscitation.
  • In the cases of an infant or child, there may not be a reliable history? In this situation, it may be difficult, if not impossible, to distinguish resuscitation injuries from pre–existing accidental or inflicted trauma.
  • It has been seen in some cases had significant autopsy–documented injuries that was initially attributed to abuse-like contusions and nail marks produced during resuscitation.
  • The State filed murder charges against the caretaker in each case. However, further history and review of the medical records suggested that resuscitation rather than pre–arrest trauma caused almost all the injuries.
  • The State dismissed the charges in the first case. A western jury returned a "not guilty" verdict in the second.
  • It is essential to consider the entire history and not just autopsy findings during a death investigation by forensic doctor or any legal agency.
    Twitter of the Day

@DrKKAggarwal: 10 simple steps to help de–stress from Health Beat

@DeepakChopra: Re checked with physicists: each cubic centimeter of empty space contains 3 × 10 to the power 37 more mass energy than in entire universe

    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Obesity in Pregnancy – National Health Service Guidelines

Primary care services should ensure that all women of childbearing age have the opportunity to optimize their weight before pregnancy. Advice on weight and lifestyle should be given during family planning consultations, and weight, body mass index and waist circumference should be regularly monitored.
Women of childbearing age with a BMI >30 should receive information and advice about the risks of obesity during pregnancy and childbirth, and be supported to lose weight before conception.

Compared to women with a healthy pre–pregnancy weight, pregnant women with obesity are at increased risk of miscarriage, gestational diabetes, pre–eclampsia, venous thromboembolism, induced labor, cesarean section, anesthetic complications and wound infections, and they are less likely to initiate or maintain breastfeeding. Babies of obese mothers are at increased risk of stillbirth, congenital anomalies, prematurity, macrosomia and neonatal death. Intrauterine exposure to maternal obesity is also associated with an increased risk of developing obesity and metabolic disorders in childhood.

    Mind Teaser

Read this………………… 

Which of the following is correct regarding Wernicke's encephalopathy?

a. Often develops into Korsakof’s even when treated.
b. It has a mortality rate of 70% to 80% if untreated.
c. The treatment is thiamine 100 mg. PO daily for 5 days.
d. The symptoms include nystagmus, ataxia and opisthotonus.
e. None of the above

Yesterday’s Mind Teaser: Which is the site for escharotomies in extremities for deep burns?

a. Anterior aspect
b. Posterior aspect of the limb
c. Medial or lateral aspect of limb
d. It can be anywhere

Answer for yesterday’s Mind Teaser: c.

Correct answers received from: Dr Prabha Luhadia, Dr Muthumperumal Thirumalpillai, Dr Anil Bairaria, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Arun Chawla.

Answer for 9th May Mind Teaser: Foreign language
Correct answers received from: Dr Jainendra Upadhyay, Dr Anupam Sethi Malhotra, Dr Aditya Rattan.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

Man: I want a divorce. My wife hasn't spoken to me in six months.
Lawyer: Better think it over. Wives like that are hard to get!

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests to rule out other causes of diarrhea and inflammation

  • Stool culture to look for bacterial infection
  • O&P (Ova and parasites) to detect parasites
  • Clostridium difficile to detect toxin created by bacterial infection; may be seen following antibiotic therapy
  • Fecal occult blood to look for blood in the stool
  • Celiac disease tests
    Medi Finance Update

(Dr GM Singh)

To bring to your notice our Income Tax Act, 1961 also considers humane side of our life and also gives deduction for contributions made for financing our country’s infrastructure development. So, in case if you pay your medical insurance premium, incur expenditure on the medical treatment of a "dependant" handicapped, donate to specified funds for specified causes, contribute in monetary form to political parties or electoral trusts, take a loan for pursuing higher education or if you are an individual suffering from "specified" diseases, then all this too can help you effectively plan your tax obligations, thus optimally reducing your tax liability. Moreover, take into account the urge to buy your dream home by taking a loan, the Act also extends tax saving benefits to you.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

1 tablet of Atazanavir 300mg & 1 tablet of Ritonavir 100mg & FDC of Tenofovir Disoproxil fumarate 300mg + Lamivudine 300mg (Each Co–pack contains:– 1 capsule of Atazanavir 300mg &
1 Tablet of Ritonavir 100mg & 1 Tablet of FDC of Tenofovir Disoproxil Fumarate 300mg + Lamivudine 300mg)

For the treatment of HIV infections in adults


    IMSA Update

International Medical Science Academy (IMSA) Update

Prevention of cancer

EPIC study, a cohort study of nearly 500,000 European men and women followed for nine years, found only a weak association between increased intake of fruits and vegetables with overall risk of cancer.

  Quote of the Day

(Dr GM Singh)

Humility makes great men twice honorable. Benjamin Franklin

    Readers Responses
  1. Dear Dr KK, Please congratulate Dr Sudhir Gupta on his getting promoted to the post of Additional Professor. Hearty Congratulations Dr Sudhir Gupta. Dr K K Arora
  2. Dear Dr Aggarwal, it is a timely reminder for medical professionals about stress management. Medical practitioners lose insight about their stress level and invariably land up with lifestyle diseases like hypertension, diabetes, peptic ulcers and addiction to tranquilizers and alcohol. We also see more and more youngsters from Metros especially in the IT field die prematurely due to poor stress management. I always tell my patients you should drive the industry, the industry should not drive you. It ultimately boils down to ancient teaching that you should lead a contended life and stop comparing with others. Dr R Mani, Psychiatrist.
    Public Forum

(Press Release for use by the newspapers )

Carbohydrates as substitute to saturated fats not the answer

More than 20 prospective studies have addressed components of diet and the risk of heart disease, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

The type of fat consumed appears to be more important than the amount of total fat.

Trans fatty acids increase risk of heart disease while polyunsaturated fat and monounsaturated fat decrease risk.

There is controversy about whether saturated fat can be substituted with carbohydrate. An increase in carbohydrate tends to reduce the level of good high density lipoprotein (HDL) cholesterol in addition to total and low density lipoprotein (LDL) cholesterol. Thus, the reduction in heart disease risk may be less than predicted by the reduction of saturated fat alone.

Observational studies have consistently shown that individuals consuming diets high in vegetables and fruits (which are rich in antioxidant vitamins) had a reduced risk of heart disease.

Results of a number of randomized trials have largely shown no significant clinical benefits of antioxidant vitamins on heart disease.

Supplemental vitamin C, E, and beta carotene cannot be recommended in the primary prevention of CHD.

Taking supplements without clinical benefits could, in theory, increase the risk if individuals mistakenly avoid therapeutic lifestyle changes or drug therapies with proven benefits.

    eMedinewS Special

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

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

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

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

  Towards Well Being

    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), India

A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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    Our Contributors

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 Naveen Dang, Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta.