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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 …

13th April, 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

Non–violent communication

"Dhoni is the best captain I played under." Tendulkar
"Indians not as large hearted as us." Afridi

These two statements made the headlines a few days back: one by Sachin Tendulkar and the other by Shahid Afridi of Pakistan. Both headlines are enough to send shivers amongst the Indians or the cricket lovers.

Many may argue that there is nothing wrong with these statements as they are nothing but individual opinions of Sachin Tendulkar and Shahid Afridi, respectively. But going into the scientific explanations both can be classified as violent communications.

Most of us engage in violent communication on a daily basis and that is what causes conflict. A violent communication is based on ‘judgment’ and not ‘observation’; giving ‘orders’ and not ‘request’ and are based on fault finding of others.

For example, "Srisanth is not a good player" is a judgment and a violent communication. "In my opinion Srisanth is a not a good player", is a personal opinion and may not be a violent communication.

Afridi’s statement above is a violent communication. Though Sachin’s statement is a personal statement and opinion but can end up into a violent communication as these types of statements are not expected from him. This a fault–finding statement. It will annoy other previous captains and their followers. What if any of the past captains say "ok, we were bad but were still better than Sachin as a captain."

A personal opinion can be a violent opinion, if it is against a person, caste or creed or the nation. The principles of non–violent communication must be taught at the school level and should be understood by journalists as well as politicians.

"Indians are not as large hearted as us," this statement of Afridi was his personal opinion and comes under non–violent communication but because it was against the nation, it is bound to find reaction from Indian community. The number one cause of misunderstanding, hatred, jealousy etc. is our day–to–day violent communications.

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

Metformin safer than other type 2 diabetes drugs

In a Danish cohort study, glimepiride, glibenclamide, glipizide, and tolbutamide were associated with an increased risk of all–cause and cardiovascular death compared with metformin, Tina Schramm, MD, of Copenhagen University Hospital, and colleagues reported in the European Heart Journal.

Metformin should be the primary drug of choice in type 2 diabetes. Schramm and colleagues assessed data on all Danish patients given an insulin secretagogue or metformin between 1997 and 2006. A total of 107,806 patients were followed for up to 9 years, with a median of 3.3 years. Glimepiride was the most used agent. Compared with metformin, all insulin secretagogues were associated with a higher risk of all–cause mortality in patients who didn’t have a prior MI: There was also an increased risk of death for those who did have a previous heart attack. However, there were no differences between metformin and gliclazide or repaglintide for either group of patients. Overall, the results were similar for other outcomes for both groups of patients, with the sulfonylureas and meglitinides carrying an increased risk of both cardiovascular death and a composite endpoint of MI, stroke, or cardiovascular death.

    eMedinewS Audio PostCard

 Rheumatoid arthritis Update

Dr Harvinder S Luthra Speaks on
‘Rheumatic arthritis: Systemic chronic inflammatory disease’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

11th Perfect Health Parade

Public enjoying a game of "Snakes and Ladder" depicting health messages during the 11th Perfect Health Parade. This game is an unique health education tool conceptualized by HCFI.

Dr K K Aggarwal
    National News

IGNOU online course on Himalayan eco–systems

NEW DELHI: Indira Gandhi National Open University’s School of Extension and Development Studies and Chair for Sustainable Development has launched an online leadership programme on Himalayan eco–systems for scientists and policy makers working in the areas of agriculture, rural development, environmental science and sustainable development. Member of Parliament Dr. Karan Singh who launched the programme earlier this week said that deforestation, population pressure and global warming are causing depletion of the ozone layer. "Unless there is involvement from Nepal, Bhutan, China, State Governments and Panchayati Raj institutions no concrete steps can be taken towards the conservation of the Himalayas. Environmental values must be integrated in school syllabus to sensitise the youth right from the start." (Source: The Hindu, Apr 11, 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)

New study shows that exercise may actually be good for your knees

If you are a runner, chances are someone has said to you that running is bad for your knees. However, a new study shows that this may not be entirely true. A group of researchers from Monash University in Australia reviewed literature on physical activity and its effects on the knee joint from the past 20 years. Researchers chose a total of 28 studies that investigated the association between physical activity and development of knee osteoarthritis and that used radiographic or magnetic resonance imaging (MRI) to determine the severity of osteoarthritis. They used the MRI data to create a system for ranking each study’s conclusions with regards to physical activity’s overall effect on the knee joint (strong evidence, moderate evidence, limited evidence or conflicting evidence). Studies were given rankings based upon several markers of joint health. The review concludes that there is strong evidence for the absence of a relationship between physical activity and "joint space narrowing," a method used to measure the amount of cartilage in the knee area and to assess joint health. Furthermore, the MRI data suggests strong evidence for an inverse relationship between physical activity and cartilage defects – which means that running may not be so bad for your joints after all!

(Dr Monica and Brahm Vasudev)

Fitness may be a better predictor than weight of whether individuals with certain heart problems will die in near future

Research published in the American Heart Journal suggests that fitness may be a better predictor than weight of whether individuals with certain heart problems are more likely to die in the near future.

Study ties cholesterol medication, diabetes

According to a study in the Journal of the American College of Cardiology, patients on a high–dose regimen of Lipitor (atorvastatin) may have an increased risk of developing type 2 diabetes, especially if they have two of the four classic risk factors for diabetes.

FDA okays brain aneurysm pipeline

The FDA has approved a flexible mesh tube, Pipeline Embolization Device, to treat brain aneurysms without open surgery. (Medpage)

ARB and CCB equivalent for preventing events in hypertensive diabetes patients

Prevention of major cardiovascular events was similar in a comparison of valsartan and amlodipine in patients with hypertension and diabetes or glucose intolerance, according to a Japanese study presented April 5 at the annual meeting of the American College of Cardiology. The Novel Antihypertensive Goal of Hypertension With Diabetes – Hypertensive Events and ARB Treatment (NAGOYA–HEART) Study is the first randomized trial to compare the effects of an angiotensin II receptor blocker (ARB) with a calcium channel blocker (CCB) on cardiovascular outcomes in this patient population. No significant differences were found between the two classes, reported Dr. Toyoaki Murohara of Nagoya (Japan) University.

    IJCP Special

Dr Good Dr Bad

Situation: A patient on HCQS developed high fever.
Dr Bad: Its classical malaria.
Dr Good: Rule out other causes.
Lesson: HCQS is hydroxychloroquine and effective against malaria.

Make Sure

Situation: An alcoholic reacted to disulfiram.
Reaction: Oh my God! Why was the drug given to him?
Lesson: Make sure that the use of disulfiram is reserved for individuals, who are highly motivated to maintain abstinence, and are either treatment-adherent or take the medication in a supervised setting.

    An Inspirational Story

(Dr Prachi Garg)

Get your priorities straight

Once at a workshop, a time management expert stood in front of the group he was presenting to and said, "Okay, time for a quiz." He pulled out a one–gallon, wide mouthed mason jar and set it on a table in front of him. Then he produced a dozen large rocks and carefully placed them, one at a time, into the jar. When the jar was filled to the top and no more rocks would fit inside, he asked, "Is this jar full?" Everyone in the group answered, "Yes." He replied, "Really?" He reached under the table and pulled out a bucket of gravel. Then he proceeded to pour the gravel into the jar. He shook the jar, causing the pieces of gravel to work themselves down into the spaces between the rocks. He continued to do this until no more gravel could fit. Then he asked once more, "Is the jar full?"

By this time, the group was onto him. "Probably not," one of them answered. "Good!" he replied. He reached under the table, brought out a bucket of sand and started dumping the sand in. It went into all the spaces left between the rocks and the gravel. Once more, he asked the question, "Is this jar full?" "No!" the group shouted. Once again he said, "Good!"

Then he grabbed a pitcher of water and began to pour it in until the jar was filled to the brim. He looked up at the group and asked, "All right, what is the point of this illustration?" One business professional raised her hand and said, "The point is, no matter how full your schedule is, if you try really hard, you can always fit more things into it!" "No," the speaker replied, "that’s not the point. The point is that if you don’t put the big rocks in first, you’ll never get them in at all."

What are the big rocks in your life? More time with your loved ones? Advancement in your education? Business growth? Greater wealth? Something else that you’ve always wanted to accomplish?

If you don’t take the time to prioritize––put your major goals in first–– then all your time will be used up by less important things.

Make an appointment with yourself today to think about and reflect on this story. Ask yourself the question: What are the major goals in my life or business? Then, remember to put these major goals in first, or you’ll never get them in at all.

    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

Can semen be collected at home?

Yes, but it must be brought to the lab within 30 min to an hour. The specimen must be collected in a container provided at the centre.

    Medicine Update

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

What is the method of action and dosage of Penicillamine?

Penicillamine acts as a chelating agent; it binds to the body copper and induces cupriuresis. Thus it helps eliminate body tissue copper in urine. It should be given by mouth on an empty stomach (1 hour before or 2 hours after meals) and at least 1 hour apart from other drugs (especially antacids), milk, or food. If you need to give iron or other products that contain minerals (such as zinc), then it should be given at least 2 hours before or after taking penicillamine

Wilson’s disease (doses titrated to maintain urinary copper excretion >2 mg/day); decrease dose for surgery and during last trimester of pregnancy

The dosage normally used are:

  • Children <12 years: 20 mg/kg/day in 2–3 divided doses, round off to the nearest 250 mg dose; maximum: 1g/day
  • Adults: 250 mg 4 times/day (maximum in older adults: 750 mg/day)
    Medicolegal Update

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

What are the effects of fasting on human health?

Body, brain and nerve tissue depend on glucose for metabolism

  • The hunger strike or food fast in the first 3 days is physiological in nature and almost always does not cause harm or pathology on body and mind because the body is still using energy from reserve glucose of body however feeling of hunger/hunger pain remain present.
  • By the fourth day of fast, feelings of hunger disappear altogether and hunger pains turn to severe gastric irritation. The body’s resources are used up and the liver starts processing body fat in a process called ketosis, transformation to an alternative form of energy, to produce ketone bodies.
  • These ketone bodies (acetoactate, hydroxybutyrate, and acetone) along with starvation begin to cause permanent and irreversible vital organ damage of the fasting person. The fast must be broken on the fifth day to avoid permanent damage to health.
  • After a week, the body enters a starvation mode and the body "mines" the muscles and vital organs for energy, and loss of bone marrow becomes life–threatening and cause fatality.
  • Brain and nerve tissue depend on glucose for metabolism. Even though the transformation to an alternative form of energy has occurred, some parts of the brain exclusively need glucose, and protein is still needed to produce it. If body protein loss continues, death will ensue.
    Legal Question of the Day

(Dr. GM Singh)

Q: What is the procedure if a child is brought dead by a mob (or group of relatives?)


  1. If there is a mob (or a group of relatives), immediately divide the doctor’s working team in two parts. One team shall explain to the parents that child is dead yet if you permit we may give some treatment but situation may not change. The second team tackles the mob that wants the child to be treated anyhow. Tell them he is already dead but the team of doctors is doing its best.
  2. Declaration of death in a child brought dead by a mob should be essentially preceded by rapid assessment and an attempt to resuscitate after talking to the group as mentioned above. This declares death at terms and conditions desired by medical team rather than swept away by the unruly behavior of the mob.
  3. When a child is brought by mob, which is not amenable to explanations, then one should surely inform police for protection and only then declare final death. The situation will be considered all the more serious, if the child is brought dead. Avoid loose talk, which may spark problems and may lead to physical abuse of medical team.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

How is metabolic syndrome defined?

The definition of metabolic syndrome depends on which group of experts is doing the defining.

Based on the guidelines from the 2001 National Cholesterol Education Program Adult Treatment Panel (ATP III), any three of the following traits in the same individual meet the criteria for the metabolic syndrome:

  1. Abdominal obesity: a waist circumference over 102 cm (40 in) in men and over 88 cm (35 inches) in women.
  2. Serum triglycerides 150 mg/dl or above.
  3. HDL cholesterol 40mg/dl or lower in men and 50mg/dl or lower in women.
  4. Blood pressure of 130/85 or more.
  5. Fasting blood glucose of 110 mg/dl or above. (Some groups say 100mg/dl)

The World Health Organization (WHO) has slightly different criteria for the metabolic syndrome:

  1. High insulin levels, an elevated fasting blood glucose or an elevated post meal glucose alone with at least 2 of the following criteria:
  2. Abdominal obesity as defined by a waist to hip ratio of greater than 0.9, a body mass index of at least 30 kg/m2 or a waist measurement over 37 inches.
  3. Cholesterol panel showing a triglyceride level of at least 150 mg/dl or an HDL cholesterol lower than 35 mg/dl.
  4. Blood pressure of 140/90 or above (or on treatment for high blood pressure).

Read this………………… 
(Dr GM Singh)

Which of the following have been consistently true in the vaccine?

a. Circumcision is protective against HPV infection.
b. Condoms protect against HPV infection.
c. HPV vaccination enhances clearance of previous infections.
d. Vaccination confers protection against vaccine type related cervical neoplasia.

Yesterday’s Mind Teaser: sweet sweet
                                          be be
                             gotten gotten gotten gotten

Answer for yesterday’s Mind Teaser: Too sweet to be forgotten

Correct answers received from: Dr K Raju, Dr Shirish Singhal, Dr K P Rajalakshmi, Dr Sumit Mehndiratta, Dr Rajshree Aggarwal, Dr S. Upadhyaya, Dr Chandresh Jardosh, Dr Anjani, Dr Y J Vasavada, Dr U Gaur, Dr Rashmi Chhibber, Dr Neelam Nath, Dr Anil Bairaria, Dr Muthumperumal Thirumalpillai, Dr Maninder Ahuja, Dr Amit Kochar, Dr Prashant Bharadwaj, Dr Anindita Sarkar, Dr Manjesha, Dr M C Kothandaraman, Dr Rakesh Bhasin, Dr Puneet Kathuria

Answer for 11th April eQuiz: E
Correct answers received from:Dr Anupam

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

"My father refused to spend money on me as a kid. One time I broke my arm playing football and my father tried to get a free X–ray by taking me down to the airport and making me lie down with the luggage."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

AFB Culture

Positive AFB cultures identify the particular mycobacterium causing symptoms, and susceptibility testing on the identified organism gives the doctor information about how resistant it may be to treatment.

  • Positive AFB smear or culture several weeks after drug treatment has started may mean that the treatment regimen is not effective and needs to be changed. It also means that the person is still likely to be infectious and can pass the mycobacteria to others through coughing or sneezing.
  • Negative AFB culture means that someone does not have an AFB infection or that mycobacteria were not present in that particular specimen (which is why multiple samples are often collected). Cultures are held for six to eight weeks before being reported as negative. If someone has TB, the infection may be in another part of the body and a different type of sample may need to be collected. A negative culture several weeks after treatment indicates that the TB infection is responding to drug treatment and that the person is no longer infectious.
    Medi Finance Update

(Dr GM Singh)

What are guaranteed returns?

Returns from mutual fund schemes are subject to market and other investment risks. As such there is no assured/guaranteed returns in mutual funds. This applies even to debt schemes. The launch of scheme/fund offering guaranteed returns is now subject to certain restrictions imposed by the SEBI, and generally SEBI does not allow guaranteed returns.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Ambrisentan film coated Tablets 5 mg/10mg

For the treatment of pulmonary arterial hypertension (WHO Group I) in patients with WHO class II or III symptoms to improve exercise capacity and delay clinical worsening.


    IMSA Update

International Medical Science Academy (IMSA) Update

Screening for cervical cancer

Two randomized trials of cervical cancer screening showed that HPV testing led to earlier detection of high–grade cervical lesions but identified large numbers of women, especially at younger ages, with lesions that would regress without treatment.

  Quote of the Day

(Dr GM Singh)

Your imagination is your preview of life’s coming attractions. Albert Einstein

    Readers Responses

It is interesting to note that you targetted BJP for waste of money I agree to waste of money But the ruling party should have agreed it too (they did under duress) About Anna Hazare, the timing of fast was good – wave of popular uprising in middle east gave an impetus to popular support and 4 state assembly election. It is as much a victory of timing and as the cause Yes critical mass was on its way. Thanks to scams after scams and media highlighting. Suresh Amin.

    Public Forum

(Press Release for use by the newspapers )

Low–calorie soup good for health

Having a bowl of low–calorie soup prior to a meal may help cut the total mealtime intake of amount of food and calories, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

As per the Penn State researchers, diners who were given, low-calorie soup made of chicken broth, broccoli, potato, cauliflower, carrots and butter to volunteers before they ate a lunch, consumed 20 percent fewer calories. The NIH study showed that all versions of soup recipe –– separate broth and vegetables, chunky vegetable soup, chunky-pureed vegetable soup, and pureed vegetable soup proved equally filling.

Consuming a first–course of low–calorie soup, in a variety of forms, can help manage weight. Using this strategy allows people to get an extra course at the meal, while eating fewer total calories.

One should take only low–calorie, broth–based soups that are about 100 to 150 calories per serving and not higher–calorie, cream–based soups.

Remember anything that is bad for your heart is bad for your brain.

    eMedinewS Special

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

2. 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


  Towards Well Being


    Forthcoming Events

April 16–17, 2011, National Conference on Gynae–Endocrinology–2011 under aegis of FOGSI, ICOG and AOGD, Focus on newer advances in management of endocrinal problems in gynaecology with emphasis on PCOS, hyperprolactinemia, amenorrhoea, hormonal contraception. Gyne– endocrinology is a topic of high importance especially for practitioner. Detailed programme http://www.aiims.edu and http://www.aiims.ac.in
For details please contact: Prof Alka Kriplani, Organizing Chairperson, 9810828717 kriplanialka@gmail.com/Dr Nutan Agarwal, organizing Secretary, 9810107464/9868397310 nutan.agarwal1@gmail.com


May 7–8, 2011, National Seminar On Stress Prevention
A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com


September 30 – October 02, 2011; XVIth World Congress on Cardiology, Echocardiography & Allied Imaging Techniques Venue: The Leela Kempinski, Delhi (NCR), September 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
Highlights of Pre – Conference CME: Case based learning experience & audience interaction, Maximum 250 delegates for CME will be accepted, who will be divided in 5 batches and will rotate to different halls every 90 minutes. The topics are:(A) Right heart pressures & functions (From basics to newer methods (RV anatomy, echo views, echo assessment of RV function, prognostic impact of RV function) (B) Carotid Doppler: How do i assess and interpret in my daily practice.: Technical tips (Anatomy of the vessel, views of ultrasound scanning, Normal & abnormal Doppler hemodynamics, how to measure IMT) (C) Valvular stenosis: Assessment, limitations and their solution: (Anatomy of the valves, 2–D findings of stenotic lesions, quantitation of lesion, limitations) (D) How do I assess and report ventricular dyssynchrony in my lab. (What is ventricular dyssynchrony, what are the types of dyssynchrony, in whom, when & why do we assess it, various echo methods to assess it ) (E) Live 3–D Echo: Protocol for acquisition. How to slice and get full information. Aim is that by end of the day, every participant is well conversant with all the topics
Dr (Col) S.K. Parashar, President, e–mail: drparashar@yahoo.com, Mob:09810146231/Dr Rakesh Gupta, Secretary General, email:jrop2001@yahoo.com, Mob:09811013246
worldcon2011@in.kyoni.com, www.worldcon2011.org


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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