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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

    Health Videos…

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

13th March 2013, Wednesday

Tdap and Flu Vaccinations during pregnancy

The prevalence of pertussis in US is increasing. Infants younger than three months of age are at highest risk. Vaccination of the mother can decrease the risk of infant exposure, and placental transfer of maternal antibodies may additionally provide a degree of passive protection to the infant for two to six months.

In 2013, the United States Advisory Committee on Immunization Practices (ACIP) has recommended that all pregnant women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, optimally between 27 and 36 weeks of gestation, regardless of prior vaccination status. Previously, Tdap was recommended only for pregnant women who had not previously received the acellular pertussis vaccine during adulthood (1).

Influenza vaccination is recommended in pregnancy as both mother and fetus are at increased risk. Maternal vaccination provides passive protection to the infant.

The safety and efficacy of vaccination of pregnant women has been confirmed in a retrospective analysis of over 100,000 pregnancies during the 2009 influenza A (H1N1) pandemic in Norway (2).

All women who are pregnant or will be pregnant during influenza season should receive the inactivated influenza vaccine, regardless of pregnancy trimester.


  1. Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 through 18 years and Adults Aged 19 Years and Older — United States, 2013 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0128a1.htm?s_cid=mm62e0128a1_e (Accessed on January 29, 2013).
  2. Håberg SE, Trogstad L, Gunnes N, et al. Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med 2013;368:333.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

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

Weight loss may improve sexual health of obese diabetes

Audio PostCard
    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

Water-based paints have least affect on environment

KANPUR: During the national seminar named PACT Vision-2013 at the campus of HBTI, GN Tewari, alumnus of HBTI, informed that the solvent-based paints pollute the environment while the water-based paints have least affect on the environment. The water-based paints are also known as green paint or eco-friendly paints. "The vapours or fumes from the solvent-based paints applied on walls or other surfaces evaporate and harm the environment. The painters who apply the solvent-based paints often fall prey to diseases like tuberculosis, asthma by inhaling the toxic solvent vapours. While there is no such harm to a painter applying the water-based paint. We, therefore, want the masses to do their bit in saving the environment," said GN Tewari, senior paint technologist. Tewari also highlighted that out of a total of 10 crore litres of solvent-based paint made every year in the country, 2.5 crore litres evaporates as vapour from the surface where it is applied. "This is a huge wastage of paint and so we are promoting the water-based paint due to this very reason," he added. GN Tewari explained that the water-based paints are costlier and therefore, the demand for the solvent-based paint is more. At present, the demand for the water-based paint is gradually increasing. He mentioned that the cost of the water-based paint is nearly 1.5 times more than the price of the solvent-based paint. (Source: TOI, Mar 12, 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)


Medical Record

A medical record is a medicolegal document. The statements of caretakers, detailed description and sketches or photographs of all of the child's injuries, emotional status of all family members must be carefully documented. It is important to document ad verbatim everything the child says that is relevant to the diagnosis.

Records are required for legal purposes and to refresh the memory in the event of court testimony, which may be required months or years later.

Documentation in the medical record should also include

  • History of previous injuries or accidents
  • Developmental history
  • Procedures performed (skeletal survey, dilated fundus exam)
  • Diagnosis (suspected child abuse, probable child abuse), followed by a descriptive summary of findings (multiple bruises of various ages)
  • Whether a child abuse/neglect report was made
  • The final disposition of the child

For comments and archives

    Valvular Heart Disease Update

Concurrent tricuspid valve surgery with chronic MR surgery

Concurrent tricuspid annuloplasty in patients undergoing mitral repair without mitral valve prolapse who have mild to moderate TR and tricuspid annular dilatation or pulmonary hypertension

(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)

Stopping rivaroxaban and warfarin temporarily in AF patients yields similar risks

Patients with atrial fibrillation (AF) at moderate to high risk of stroke who briefly stop oral anticoagulation with rivaroxaban (Xarelto, Bayer/Janssen) have similar risks of clinical events as those treated with warfarin. The temporary interruption resulted in very few strokes or thrombotic events and a low rate of bleeding in both rivaroxaban- and warfarin-treated patients. (Source: Medscape)

STREAM: First success for fibrinolysis before transport to PCI

Fibrinolysis with tenecteplase and contemporary antithrombotic therapy given before transport to a PCI-capable hospital coupled with timely coronary angiography is as effective as primary PCI in STEMI patients presenting within three hours of symptom onset who cannot undergo primary PCI within one hour of first medical contact, the STREAM trial has shown. (Source: Medscape)

SELECT-ACS: Hints of myocardial sparing with inclacumab in NSTEMI

A small, phase 2 study, with a biomarker test for its primary end point, offers some encouraging hints that the P-selectin antagonist inclacumab may be able to reduce myocardial damage in patients undergoing PCI for non-ST-elevation MI. (Source: Medscape)

Brisk walking steps up stroke rehab

Aerobic walking several times a week for 30 minutes duration improved strength and stamina in chronic stroke patients, a small, randomized trial found. (Source: Medpage Today)

Domperidone under scrutiny in Europe due to cardiac risks

European Union (EU) drug regulators announced yesterday that they have begun a review of domperidone, an antiemetic, because of concerns about adverse cardiac events, including QT prolongation and arrhythmias. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Boiled water is the safest water to drink. http://bit.ly/YXhN6P #Health

@DrKKAggarwal: You are life itself & life is not subject to birth & death, only its names & forms

    Spiritual Update

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

The Right Action

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.

For comments and archives

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

What is the use of assisted hatching indicated?

The use of assisted hatching in all patients is not recommended. Assisted hatching should be reserved for patients who may have a harder time achieving pregnancy (poor diagnosis). This includes women who aged 38 years or older using their own eggs, patients with 2 or more failed IVF cycles, and those who had been noted to have poor embryo quality.

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

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

Primary reason for transfusing blood

Tests must be performed to ensure

  • Safe administration of donor blood to patient
  • A pregnancy as safe as possible for both mother and child.

For comments and archives

    An Inspirational Story

Why is there war?

It was my first day at school. I felt nervous and scared. I went to all my classes with no friends. It felt like no one cared. I listened anxiously to all the lessons and waited for lunch break at one. Then finally the bell rang. It was time to talk and have fun. In the lunchtime I met a new friend who wore a hijab on her head, and though I am Jewish, we got along fine, and I was so relieved when she said, “Sit with us, at our table.” She pointed to the one next to the door.

So I agreed, and took my tray and was about to walk with her across the floor, when suddenly I felt a nudge. “Hey, I saw you on the bus,” said a tall girl in a long skirt. “I see your Jewish star necklace. You should sit with us.”At that moment I looked around, and that’s when I noticed, to my surprise, the nations of the world, isolating themselves. That’s what I saw through my own eyes.

The Spanish only sat with Spanish, the Hindus only with Hindus, the Russians always with the Russians, and never the Arabs with the Jews. I saw the reason why war gets started. Everyone sticks to their own kind. The lunchroom was a map of the world. Why was everyone so blind? And so I turned down this girl, and went with the first, and there was no enmity. I built a bridge between two worlds when I sat with those different from me. Hope you will do the same.

For comments and archives

    Cardiology eMedinewS

Systematic care helps urban poor control BP Read More

CDC says be on alert for new coronavirus Read More

    Pediatric eMedinewS

Infant bruising may signal later abuse Read More

Immunity wanes after last dose of DTaP vaccines 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 common animal reservoirs of rabies?

Rabies exists in two forms:

  • Urban Rabies, propagated chiefly by unimmunized dogs.
  • Sylvatic rabies, propagated by skunks, foxes, raccoons, mongooses, wolves, bats etc.

Worldwide, the most common cause by far of human rabies infection is dog bite. The host animals of the rabies virus differ among regions, even though almost every mammal is capable of contracting rabies. The main vectors are foxes in Europe and Canada, raccoons, skunks, and fruit-eating and insectivorous bats in the United States, dogs in Asia, mongooses, jackals, and dogs in Africa, and dogs and vampire bats in Latin America.

In India, the animals commonly responsible for transmission of rabies are dogs and cats (97%) followed by wild animals like mongoose, foxes and jackals (2%) and occasionally by horses, donkeys, monkeys, cows, goats, sheep and pigs.

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady was on PPI.
Dr Bad: Stop it.
Dr Good: Continue it.
Lesson: Proton pump inhibitors (PPIs) are not a major cause of birth defects when used early in pregnancy (N Engl J Med 2010;363:2114–23).

Make Sure

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Reaction: Oh My God! Why was acetazolamide not started before the journey?
Lesson: Make sure all high risk patients are given acetazolamide before they travel to mountains.

  Quote of the Day (Dr GM Singh)

Just know, when you truly want success, you’ll never give up on it. No matter how bad the situation may get.

    Mind Teaser

Read this…………………

According to the American Hospital Association's Patient's Bill of Rights, patients are responsible for:

1. Accepting the treatment decisions of the medical and nursing team.
2. Allowing HIV testing when a staff member experiences a body fluid exposure.
3. Participating in the hospital's research studies.
4. Providing information about past illnesses, hospitalizations, and medications.

Yesterday’s Mind Teaser: Patients taking furosemide (Lasix) are instructed to notify their health care practitioner if they develop:

1. A change in appetite
2. A disruption in sleep patterns
3. Increased urinary frequency
4. Leg cramps

Answer for yesterday’s Mind Teaser: Leg cramps

Correct answers received from: Dr K Raju, Dr PK Sahu, Dr Shashi Saini, Rajiv Kohli, Dr B Srinivas, Selva Pandian, Dr PC Das, Dr Bharat Bhushan Aggarwal,
Dr KV Sarma, Dr (Maj. Gen.) Anil Bairaria,, Dr Jella, Dr Pankaj Agarwal,
Dr Jainendra Upadhyay, Dr Chandresh jardosh, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta Jain, Dr Bharat Bhushan Aggarwal, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 11th March Mind Teaser: Discuss community resources with the wife and offer to make referrals

Correct answers received from: Dr Avtar Krishan, Dr Kanta Jain, Dr Bharat Bhushan Aggarwal, Dr Jayashree Sen & Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

A mathematician, a physicist, and an engineer

A mathematician, a physicist, and an engineer were traveling through Scotland when they saw a black sheep through the window of the train.

"Aha," says the engineer, "I see that Scottish sheep are black."

"Hmm," says the physicist, "You mean that some Scottish sheep are black."

"No," says the mathematician, "All we know is that there is at least one sheep in Scotland, and that at least one side of that one sheep is black!"

    Medicolegal Update

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

How is a blood sample collected in a medicolegal case?

Collection of a blood sample is said to be a surgical process and should only be performed by a qualified doctor in a hospital setup where at least primary medical facility is available because in many occasion the patient may develop medical complications and even loss of consciousness. Hence, it cannot be drawn in police station or court of law.

  • The sample should be taken from the vein in the antecubital fossa.
  • Before blood collection, the subject should remove tight clothes that might constrict the upper arm.
  • The phlebotomist ties the tourniquet around the upper arm of the subject, searches the proper vein by inspecting and palpating and then sterilizes the injection site.
  • The vein can be anchored by placing the thumb about 2 cms below the vein and pulling gently to make the skin a little taut.
  • After that, the needle, beveled upward, should be pushed smoothly and quickly into the vein, to minimize the possibility of hemolysis as a result of vascular damage.
  • Immediately after the insertion, the tourniquet should be released to minimize the effect of hem concentration.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Restricting salt in diet can lower heart disease risk

Restricting salt in the diet can lower the risk of developing heart disease by 25 percent and the risk of dying from heart disease by 20 percent, 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.

Dietary intake of sodium among Indians is excessively high. Quoting a Harvard Medical School study published in British Medical Journal, Dr Aggarwal said that among hypertensive individuals, lowering sodium is quite well established to lower blood pressure, but now it has been shown that reducing salt also has an effect on cardiovascular disease.

When people with pre hypertension (blood pressure more than 120/80 and lower than 140/90), reduced their salt intake by about 25 to 35%, they were 25% less likely to develop cardiovascular disease 10 to 15 years after the trial ended. There was also a 20 percent lower death rate from cardiovascular disease among those who cut their salt consumption.

Salt restriction is best achieved by avoiding salted, salt cured and salt smoked foods such as lunch meat, hot dogs, ham, olives, pickles and regular salted canned foods, and other prepared foods, which often use more salt than homemade equivalents. Foods we would never think of as salty, such as breakfast cereals, cookies, and even some soft drinks, often contain copious additions of sodium.

WHO recommends limiting the salt intake to less than 5 grams per day, added Dr Praveen Chandra Chairman Cardiology at Medanta - The Medicity.

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 30649 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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  1. Dear Sir, we gain lot of knowledge from emedinews. Regards:Dr Tarandeep
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