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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 …

12th September 2011, Monday

Ventilator–associated tracheobronchitis

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 (1) 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.

Ventilator induced diaphragmatic atrophy

Controlled mechanical ventilation can lead to a very rapid type of disuse atrophy involving the diaphragmatic muscle fibers. An observational study found that diaphragmatic strength decreased progressively during mechanical ventilation and that long–term (>24 hours) mechanical ventilation was associated with diaphragmatic muscle injury, atrophy, and proteolysis compared to short–term mechanical ventilation (2–3 hours).(2)

Starting enteral nutrition in a patient on ventilator

Starting enteral nutrition with a low infusion rate improves tolerability, compared to initiation at the target rate. A randomized study of 200 mechanically ventilated patients showed that enteral feeding (at the target rate or at 10 mL/hr for six days before being incrementally increased to the target rate) showed no differences in mortality, ventilator–free days, or ICU-free days, but the group that began at the target rate had more episodes of elevated gastric residual volumes and a trend toward more diarrhea.(3)


  1. Dallas J, Skrupky L, Abebe N, et al. Ventilator–associated tracheobronchitis in a mixed surgical and medical ICU population. Chest 2011;139:513–8.
  2. Jaber S, Petrof BJ, Jung B, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med 2011;183:364–71.
  3. Rice TW, Mogan S, Hays MA, et al. Randomized trial of initial trophic versus full–energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med 2011;39:967–74.

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

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Ventilator–associated tracheobronchitis

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    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Students were Awarded for their best performance in the Heritage - Festival of Classical Dances, in the 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


Community-based health workforce crucial, says SEAR committee

JAIPUR: Health ministers and experts at the 64th session (September 6 to September 9) of the Regional Committee for South-East Asia in Jaipur on Wednesday agreed that a well-trained, well-equipped and well-supported community-based health workforce is the backbone of the primary health care-based health system. They agreed that community-based health workforce needs to be carefully selected, appropriately trained and continuously supported by the health system. They must be recognised as an integral part of the health system and the referral chain within it. In India, over 8 lakh Accredited Social Health Activists (ASHAs) are trying to revitalise the rural health care system under the National Rural Health Mission. ASHAs act as a link between the community and the health system. Apart from India, countries as Thailand, Timor-Leste, Bangladesh, Indonesia and Nepal, too, have community health workers for better health care. (Source: TOI, Sep 8, 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)

Strokes or death more likely with brain stent

Aggressive medical therapy was more than twice as effective in lowering the risk of recurrent stroke or death than was stenting of narrowed intracranial arteries (Medpage reports)

For comments and archives

FDA Panel waffles on limiting duration of bisphosphonate use

A FDA advisory committee wants the agency to limit the duration of bisphosphonate therapy for treatment of osteoporosis, but the committee could not agree on what that time limit should be. (Source: Medpage Today)

For comments and archives

FDA to test new ways to trace food

The FDA has announced the start of two pilot programs to will help develop new tracking systems that will allow investigators to identify sources of foodborne disease outbreaks more quickly than is now possible. One of the programs focuses on processed foods, while the other targets raw fruits and vegetables. They mainly emphasize more detailed recordkeeping in the food production and distribution industries. (Source: Medpage Today)

For comments and archives

    Fitness Update

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

Increased resistance training does not benefit cardiac rehabilitation patients

For patients undergoing rehabilitation following cardiac events, aerobic exercise training (AT) is widely recommended. Resistance training (RT) has also been shown to be beneficial because it enhances muscular strength and endurance, functional capacity and independence, and quality of life, while reducing disability. In a study scheduled for publication in the October issue of the Archives of Physical Medicine and Rehabilitation, researchers compared two RT regimens of different intensity in combination with AT. They determined that higher volume of RT in combination with AT does not yield any additional benefits.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #IJMD The use of the lingual technique for forced eruption enhance acceptance of orthodontic treatment by adult… fb.me/1f9WPekSY

@DeepakChopra: You can never be wrong about destiny. Whether you succeed or not, you are proven to be right.

    Dr KK Answers

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

Can weight loss help diabetic sexual functions?

Weight loss improves the sexual health of obese men with type 2 diabetes, according to a study published in the Journal of Sexual Medicine. A modest weight loss of 5% can lead to an easing of erectile dysfunction and improvement in sexual desire within 8 weeks and positive effects continue to improve in the next 12 months. The typical weight reduction diet involves consuming low–calorie diet or a low–fat, high–protein, reduced–carbohydrate diet meant to decrease calorie intake by 600 calories a day.

For comments and archives

    Spiritual Update

The Right Action: The Dharma

Dharma is the path of righteousness and living one’s life according to the codes of conduct as described by the Vedas and Upanishads. Its western equivalents might include morality, ethics, virtue, righteousness and purity. The term dharma can best be explained as the "law of being" without which things cannot exist.

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    An Inspirational Story

(Ms Ritu Sinha)

Grandmother’s Vase

One day I was lying on the bed, reading, when my mother came into the room. She held out a vase––a rather ugly vase. She asked, ‘Would you like to have this vase?’ "I replied quickly, ‘No, I don’t want it.’ "As she turned to walk away, I picked up something that said to me, ‘Wait a minute, don’t shut this off yet.’ So I asked, ‘Where did you get it?’

"She said, ‘Oh, I got it when I filled an order.’ Filled an order? I thought––no communication here. So I asked, ‘What do you mean, filled an order?’ ‘Well,’ she said, ‘when I was a little girl, the Smith Company mailed catalogs to people. I would take the catalog around the neighborhood, and I’d get people to order from it. When I filled an order and sent it in, they gave me a prize. One time, I got a porch swing for my family.’

"Now you have to understand," said Hensley, "that my mother is 81–years–old. She is one of six children in a family that her father deserted when she was quite young. Money was real hard to come by. My grandmother managed to keep the family together through the years, although I don’t know how. For my mother to win a luxury like a porch swing was a significant accomplishment. Although she no longer had the swing, she had the vase––a vase full of meaning––which she offered to me. Instantly I said, ‘Mom, I want the vase.’ Now it sits in a prominent place in my living room.

It symbolizes a precious meaning which my mother and I share. Unless you and I are sensitive to the other person and hear meaning, we may well have a communication problem.

For comments and archives

    Gastro Update

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

What is the nutritional management of IBD?

Nutrition is an integral part of the management of children with IBD, and nutritional status should be assessed at presentation and at follow–up. Exclusive enteral nutritional therapy modifies disease in children with Crohn’s disease (CD). There are 2 types of enteral feeding: elemental (amino acids + short–chain fatty acids + short–chain carbohydrates + vitamins) and polymeric (whole protein). Elemental diets are very useful but are unpalatable, so polymeric diets are preferred in children. Therapy lasts for 6 weeks followed by gradual re–introduction of normal diet. Nutritional support should be considered as an adjunctive therapy for any patient with CD or ulcerative colitis (UC) with malnutrition. Nasogastric/gastrostomy tube feeding can be considered.

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

CUPART 2011 (Current Practices and Recent Advances in ART)

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

Session 4 – Assisted Conception in Routine Gynaecological Practice

This session aims to cover important area of infertility practice which a gynaecologist should be equipped with to give better results and have satisfied patients. The gynaecologist should also know and accept limitations of such treatment and refer to a tertiary centre at the right time.

Speakers: Dr Ashok Khurana (New Delhi), Dr Rohit Gudgudiya (Kolkata), Dr Geeta Radhakrishna (New Delhi), Dr Nalini Mahajan (New Delhi)

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

For details contact +91 9871250235

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum lithium

To determine lithium levels in the blood in order to maintain a therapeutic level or to detect lithium toxicity.

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    IJCP Special

Dr Good Dr Bad

Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.
Dr Bad: Do not worry.
Dr Good: Rule out diabetes.
Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).

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Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, give the patient water–soluble aspirin to chew in order to reduce chances of sudden death.

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    Quote of the Day

(Dr.Chandresh Jardosh)

People who Change AFTER Change will Survive… People who Change WITH Change will Succeed…People who CAUSE the Change will Lead…


(Ms Ritu Sinha)

Head over heels: Very excited and/or joyful, especially when in love.

    Medicolegal Update

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

Cannabis is also known as marijuana

Indian hemp, hashish, ganja, pot, dope and grass, is made from the Indian hemp plant Cannabis sativa

  • Cannabis is often abused and, in some countries it is used almost as much as alcohol or tobacco and considered as aphrodisiac agent. It makes people feel relaxed and makes colors and sounds seem brighter and louder. The dried plant is made into cigarettes or put in a pipe and smoked. Sometimes it is taken with food also however some people inject it too.
  • Cannabis causes harm affects to the brain however it does not cause much harm to adults, unless it is injected. The signs and symptoms start within 10 minutes of smoking the drug and last for about 2–3 hours.
  • When the drug is eaten, the effects start within 30–60 minutes and last for 2–5 hours. The main effects are a feeling of well–being, happiness and sleepiness, but high doses may cause fear, panic and confusion, the person cannot balance when standing up, hallucinations, drowsiness, slurred speech, coughing if the drug is breathed in, as when smoking cigarettes.
  • If the drug is injected it may cause more serious problems severe headache, dizziness, irregular breathing, fever, low blood pressure, unconsciousness.
  • If the patient is unconscious or drowsy, lay him or her on one side in the recovery position. Check breathing every 10 minutes. A patient who is anxious or confused should be kept in a quiet, warm room. If the cannabis was swallowed: there is no need to make the patient vomit. If the patient is fully awake, breathing normally, and not vomiting, gives activated charcoal and water to drink.
  • If the patient is hallucinating or violent, give chlorpromazine, 50–100 mg an adult dose, intramuscularly.
  • If cannabis has been injected, monitor breathing, pulse, blood pressure, temperature. Supportive care, including oxygen and mechanical ventilation, should be given as needed: Low blood pressure should be treated by keeping the patient lying with the feet higher than the head; intravenous fluids can be given.

For comments and archives

    Mind Teaser

Read this…………………

The carpal tunnel contains all of the following important structures except:

1. Median nerve
2. Flexor pollicis longus
3. Flexor carpi radialis
4. Flexor digitorum superficialis

Yesterday’s Mind Teaser: HPV vaccine is a:

a. Live attenuated vaccine
b. Heat inactivated vaccine
c. Killed vaccine
d. Virus–like particle vaccine

Answer for Yesterday’s Mind Teaser: d. Virus–like particle vaccine

Correct answers received from: Puneet Kalra, Dr. Dilip Kumar Jha, Dr Y. J. Vasavada, Dr.K.Raju, Dr. Anil Kumar Jain, Dr. Gunjesh kumar, Dr. Anil Kumar Jain, Dr Chandresh  Jardosh, DrValluri Ramarao, Dr Muthumperumal Thirumalpillai, Anil Bairaria, Dr. Anil Kumar Jain, Dr Chandresh  Jardosh

Answer for 9th September Mind Teaser: 3. Femoral artery
Correct answers received from: Dr Neelam Nath, Dr. Gunjesh kumar, Dr. Anil Kumar Jain, Dr Chandresh  Jardosh, Dr Shirish Singhal, Dr. Anjani, Dr.K.V.Sarma,

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr. GM Singh)

Senior Personal Ads

WINNING SMILE: Active grandmother with original teeth seeking a dedicated flosser to share rare steaks, corn on the cob and caramel candy.

    Drug Update

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

Drug Name
DCI Approval Date
Pidotimod Tablet 400 mg/800 mg & Oral Solution 400 mg/800 mg per 7ml
For infections of the respiratory system in secondary and primary immunodeficiency with alteration in maturation of T cells in adults only.
    Public Forum

(Press Release for use by the newspapers)

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

Medico Masti – College and Youth Festival at MTNL Perfect Health Mela

18th Medico Masti, an inter college health festival will be organized on Saturday, 22nd October, 2011 at MTNL Perfect Health Mela to be held at NDMC Grounds Laxmibai Nagar, New Delhi. Over 50 colleges from NCR including medical colleges 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 in association with Maulana Azad Medical College and Delhi Institute of Pharmaceutical Science and Research (DIPSAR).

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President of Heart Care Foundation of India and MTNL Perfect Health Mela said that competitions like Fashion Show, Choreography, Rock Band etc. would be organized on the spot.

The theme this year is Science behind Rituals. The various competitions include: Dance, Quiz, singing competition, Choreography, Fashion Show etc.

Dr. Aggarwal said that infotainment is a new concept of creating health education where education is inter linked with entertainment.

The infotainment modules used are:

  1. Competition theme is based on health.
  2. Social advertisements are displayed in between the competitions
  3. Short talks are arranged in between the two competitions.
  4. Social messages are passed on to the public in the award ceremony in between every two award distribution.

For comments and archives

    Readers Responses
  1. Respected Sir, I appreciate the editorial on Hepatitis B vaccination update for the wonderful clarity and content. Dr. Dilip Kumar Jha
  2. Dear Dr Aggarwal, We all are saddened by the bomb blast in Delhi High court. We sympathise with the victims and their families. There are disturbing reports of attendants not being permitted to enter inside the ward to be with their nears and dears.
    There are valid security concerns but the following measures can be taken.
    I wish immediate measures to be taken to avoid long term mental trauma for the relatives
    1. Medical Superintendent should follow medical ethics and exercise his authority to call the attendants. He can coordinate with police personnel and at least one attendant of each person should be allowed, escorted by a policeman to see the condition of his ward and if he wishes to shift to some other hospital he should be allowed.
    2. Medical superintendent should issue a bulletin every hour or two for the seriously injured inside the waiting area and should invite any suggestion for help.
    I request you to kindly take personnel interest on behalf of medical community to sort out this problem. Sincerely, Dr R S Bajaj, Paediatrician, Rohini, Delhi
    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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