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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 May 2011, Friday                                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

No safe duration of NSAIDS

There is no "safe" duration for NSAID use in patients with a history of myocardial infarction, according to an analysis of data from more than 83,000 patients -- use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

The common NSAID diclofenac was associated with a 3.52 HR for death during the first week of use, according to Anne-Marie Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark, and colleagues in Circulation, Journal of the American Heart Association. That's a higher risk of death at the initiation of treatment than was seen with rofecoxib which was withdrawn from the market in 2004. For ibuprofen, which was the most commonly used NSAID, the increased risk was seen for treatment lasting more than a week. Among the findings:

  • All NSAIDs increased risk of death or recurrent MI by 45% after a week (HR 1.45, 95% CI 1.29 to 1.62).
  • Naproxen increase the risk of death or recurrent MI by 76% after a week (HR 1.76, 95% CI 1.04 to 2.98), but for treatments lasting 30 to 90 days the risk increased risk was 15% (HR 1.15, 95% CI 0.80 to 1.65).
  • Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less (HR 1.04, 95% CI 0.83 to 1.30).

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

Aspirin dose for patients with acute coronary syndrome undergoing PCI

In patients who are at high risk of bleeding start a daily dose of aspirin of 75 to 162 mg rather than higher doses beginning the day after PCI with either bare-metal or drug-eluting stents. In patients who are not at high risk for bleeding, also start this dose rather than higher doses.

  eMedinewS Audio PostCard

Chronic Hepatitis B: Optimum vaccination schedule

Dr Neelam Mohan Speaks on
‘Hepatitis B: Transmission’

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

World Earth Day 2011

Students of Delhi Public School, Mathura Road depicting the message to preserve earth.

Dr K K Aggarwal
    National News

In a first, women No.1 and No.2 in civil services exam

History has been made in this year's civil services' results. In a rare first, the top two candidates are women. Topper S Divyadharshini is an alumnus of Dr Ambedkar Law University in Chennai. Sweta Mohanty, who did her B Tech in computer science from Gokaraju Rangaraju Institute of Engineering and Technology (GRIET), Hyderabad, has come second. The merit list boasts of five women candidates in the top 25. R V Varun Kumar, a student of Chennai's Ragas Dental College, has topped among the male candidates. Overall, he came third. (Source: TOI, May 12, 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 )

May is national Employee Health and Fitness Month (EHFM)

The National Association for Health and Fitness holds this monthly observance each year. The goal of EHFM is to promote the benefits of a healthy lifestyle to employers and their employees through worksite health promotion activities and environments. This month, encourage your members to get involved in their workplace wellness programs - or even start their own!

(Dr Monica and Brahm Vasudev)

One in seven strokes may wake up with stroke symptoms

One in seven strokes happens at night, and sufferers may not get medicine that could prevent brain damage, suggests a new study published in Neurology.

Osteoporosis drugs hike femur fracture risk

Use of bisphosphonates for osteoporosis increased the risk of femoral shaft fractures by nearly 50-fold in a large Swedish cohort study, but the absolute risk still remained very small. (according to Per Aspenberg, MD, of Linköping University in Sweden, and colleagues).

PAS: Secondhand smoke may increase BP in boys

Exposure to secondhand tobacco smoke appears to be associated with higher blood pressure in boys, researchers found. Among boys ages 8 to 17, those who lived with a smoker had an average systolic blood pressure that was 1.6 mm Hg higher than in those who did not live with a smoker (p<0.001), according to Jill Baumgartner, PhD, a research fellow at the University of Minnesota’s Institute on the Environment in St. Paul.

    Spiritual Update

Hanuman Chalisa

Laye Sanjivan Lakhan Jiyaye
Shri Raghubir Harashi Ur Laye

Meaning: You brought the medicinal herb to revive Lakshmana, and overcome with joy Rama embraced you and glorified you.

Spiritual Significance: With Meditative Chakra Pranayama, one acquires healing powers with has a value similar to that of super medicinal herbs. Our consciousness has the capacity to produce each and every drug. We know that no drug can work in the body unless it identifies a receptor within. God never made these receptors for the pharma companies. The very fact there is lock within, the body has the key as well as capacity to relocate or remake that list key. By being in touch with the consciousness, one can acquire these powers to relocate the lost key and heal oneself.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with community acquired pneumonia wanted to avoid admission
Dr Good: Take double dose of levofloxacin
Dr Bad: You need admission
Lesson: A randomized multicenter trial of 619 hospitalized patients with community acquired pneumonia compared the efficacy of higher doses of levofloxacin (500 mg twice daily) or ceftriaxone (4 g IV once daily), and found equivalent clinical responses two to five days following therapy (87 versus 86 percent cure or improvement) (Scand J Infect Dis 1998;30(4):397-404).

Make Sure

Situation: A patient with fasting sugar of 99 mg% developed diabetes after 6 months
Reaction: Oh my God! Why was the fasting sugar of 99 ignored?
Lesson: Make sure that fasting sugar is kept < 80 mg%. According to a study in April 15 in the journal Diabetes Care, patients whose normal fasting plasma glucose levels are at the upper end of the normal range may be twice as likely to develop type 2 diabetes as patients whose blood sugar levels fall within the lower range of normal.

    An Inspirational Story

(Dr Prabha Sanghi)

The travelling monks at the river

Two traveling monks reached a river where they met a young woman. Wary of the current, she asked if they could carry her across. One of the monks hesitated, but the other quickly picked her up onto his shoulders, transported her across the water, and put her down on the other bank. She thanked him and departed. As the monks continued on their way, the one was brooding and preoccupied. Unable to hold his silence, he spoke out. "Brother, our spiritual training teaches us to avoid any contact with women, but you picked that one up on your shoulders and carried her!"

"Brother," the second monk replied, "I set her down on the other side, while you are still carrying her."

Lesson: The practice of one's belief is more important than rigid adherence to a belief in one's practice.

    Pediatric Update

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

How do we diagnose galactosemia?

Diagnosis is made by demonstration of reduced or absent activity of the enzyme galactose–1–phosphate uridyl transferase (GAL–1–PUT) which is central to galactose metabolism. This test is invalid if the child has received a blood transfusion within previous 2 months. Parents’ samples should be sent instead for carrier testing.

    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

What are the indications of Therapeutic Donor Insemination (TDI)?

When the male partner has azoospermia, severe oligospermia, or other significant sperm or seminal fluid abnormalities or has ejaculatory dysfunction. It demonstrates significant male factor infertility i.e. failure in fertilization after insemination in vitro, and intracytoplasmic sperm injection (ICSI). The female partner is Rh-negative and severely Rh-iso-immunized and the male partner is Rh-positive. If the male partner has a sexually transmissible infection that cannot be eradicated.

   Twitter of the Day

@DrKKAggarwal: 1/7 strokes may wake up with stroke symptoms and sufferers may not get medicine that could prevent brain damage (Neurology).

@PritishNandy: UN says over one billion tonnes of food is wasted every year. Yet millions go hungry to bed every night.

    Rabies Update

(Dr AK Gupta, Author of "RABIES – the worst death")

A dog/cat became unavailable or disappeared for observation from day 4 and the patient was given modern vaccine on day 7 (third dose). Subsequently, from day 8, it reappeared. What should be done?

The dog/cat should be observed till day 10 or wherever possible up to day 15, and if it is healthy, then the fourth injection due on day 14 is not required. Three injections may provide protective antibody titers for about/up to 3 months.

A patient received two doses of modern vaccine (on days 0 and 3) and the dog was well on days 5 and 7 (third injection due, but not given). However, the dog dies on any day between 8 and 15. What should be done?

In case, day 0 and 3 injections were given and injection due on day 7 was postponed because the dog was kept under observation but the dog dies between 8 and 15 days, then three doses of vaccine must be given as close to the original dates of the schedule and all five injections must be completed by day 28.

    Medicolegal Update

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

Incised looking laceration is not an incised wound

The wounds produced by a blunt weapon or by a fall on the hard surface, object, on tense structures/skin covering the bones, such as the scalp, eyebrow, iliac crest, shin, perineum, knee or elbow when the limb is flexed look like an incised wound. However, these are lacerated wounds, also called split lacerations that are caused by blunt force and create confusion in the minds of doctors, public and police officials about a sharp weapon.

  • When the incised looking wounds are examined by a doctor under magnifying lens the edges of such wounds are found to be irregular with bruising and wounds. These are produced by a blunt weapon.
  • The wounds which are also produced by pieces of glass, broken crockery have the characteristics of incised wounds but the edges appear parallel with one end of the wound. For example, an injury to a finger/body as a neatly incised laceration/split laceration or incised looking wound caused by broken glass. A neatly incised laceration is considered as incised wound.
  • An incised wound, cut, slash, and slice is a clean cut through the skin, may or may not involve underlying tissues and structures caused by sharp edged instruments, which is longer than the depth of wound. It is produced by infliction of an object with a sharp cutting edge such as knife, razor, blade, scalpel, sword.
  • During the preparation of MLC report, the doctor should keep in mind that he has to provide clues about the weapon used, whether it is sharp edged or otherwise, the direction of the force, duration of injury, and the location of the wound, which may suggest mode of production i.e. suicide, accident, homicides along with whether the injury is fabricated or otherwise.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Obesity in pregnancy --- national health service guidelines

Women with a booking BMI =40 should have a documented assessment in the third trimester of pregnancy by an appropriately qualified professional to determine manual handling requirements for childbirth and consider tissue viability issues.

Manual handling requirements include consideration of safe working loads of beds and theatre tables, the provision of appropriate lateral transfer equipment, hoists, and appropriately sized thromboembolic deterrent stockings (TEDS). There is also an increased risk of pressure sores when a woman may be relatively immobile and regular inspection of potential pressure areas is important. A formal assessment of this risk should be made using validated scoring tools, and appropriate plans put in place with regard to body positions, repositioning schedules, skin care and support surfaces.

For women with obesity in pregnancy, re-measurement of maternal weight during the third trimester will allow appropriate plans to be made for equipment and personnel required during labor and delivery.

    Mind Teaser

Read this…………………

(Dr GM Singh)

Which is the most serious complication of the supracondylar fracture of the humerus ?

a. A compartment syndrome of forearm
b. Failure to heal
c. Healing in a non anatomic position
d. Injury to the median nerve
e. Permanent restriction of the elbow motion

Yesterday’s Mind Teaser: What happens only in the middle of each month, in all of the seasons, except summer and happens only in the night, never in the day?

Answer for yesterday’s Mind Teaser:
The letter N. The middle of each month, in all of the seasons and happens in the night, never in the day.

Correct answers received from: Dr Vijay Kansal, Dr BN Ganagdhar, Dr Anshu Sharma, Dr Anil Kumar, Dr YJ Vasavada, Dr Rajni, Dr Shikha.

Answer for 4th May Mind Teaser: d.
Correct answers received from: Dr Prabha Sanghi, Dr Anupama, Dr Prachi, Dr Shweta, Dr Karan, Dr SM Jha.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Super Bowl

A man had 50 yard line tickets for the Super Bowl. As he sits down, a man comes down and asks if anyone is sitting in the seat next to him. "No," he says, "The seat is empty." "This is incredible," said the man. "Who in their right mind would have a seat like this for the Super Bowl, the biggest sporting event in the world, and not use it?" He says, "Well, actually, the seat belongs to me. I was supposed to come with my wife, but she passed away. This is the first Super bowl we haven't been to together since we got married in 1967."

"Oh, I'm sorry to hear that. That's terrible. But couldn't you find someone else-a friend or relative, or even a neighbor to take the seat?" The man shakes his head. "No, they're all at the funeral."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

INR International Normalized Ratio (INR)

To monitor the effectiveness of blood thinning drugs such as warfarin (anti clotting drug which inhibit the formation of blood clots).

    Medi Finance Update

(Dr GM Singh)

What is hedge fund?

Hedge fund is a fund that may employ a variety of techniques to enhance returns. In a bull market, they may be long, in a bear market they may be short; they are also allowed to borrow to enhance returns. Hedging is a strategy designed to reduce investment risk.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Lornoxicam 4mg + Eperisone 50mg tablet
For the improvement of myotonic conditions caused by neck shoulder arm syndrome, scapulohumeral periarthritis and low back pain in adult patients only
    IMSA Update

International Medical Science Academy (IMSA) Update

Screening for cervical cancer

Two randomized trials evaluated HPV screening, in conjunction with cytology, for cervical cancer screening. 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 (Lancet Oncol 2009;10:672, Lancet Oncol 2010;11:249.)

  Thought of the Day

(Dr GM Singh)

Talent is God given. Be humble. Fame is man-given. Be grateful. Conceit is self-given. Be careful. John Wooden

    Readers Responses
  1. Dear Dr Aggarwal, Nurses are the most important part of our success. A good efficient OT nurse contributes a lot to a surgeon’s performance; a good ward nurse makes a radical change in the outcome of the efforts made by the doctor. It is so heartening to see you remember Nurses Day. Dr Vivek Kumar,Varanasi.
    Public Forum

(Press Release for use by the newspapers)

Heat stroke

Heart Care Foundation of India today released guidelines and common mistakes done either at the level of the patient or at the level of the management.

Releasing the guidelines Padma Shri & Dr B C Roy National Awardee Dr KK Aggarwal and President, Heart Care Foundation of India said that there are two types of heat stroke. Exertional heat stroke occurs in younger individuals who engage in strenuous physical activity for a prolonged period of time in hot environment. The classical non-exertional heat stroke more commonly affects sedentary elderly individuals or in persons who are chronically ill and/or younger children.

If therapy is delayed, the mortality is 80%, which can be reduced to 10% if early proper management is done, and mistakes avoided.

Mistake No. 1
Missing Diagnosis: It is the rectal temperature, which is more important than axillary or oral temperature. The person may have heat stroke, which may be missed if rectal temperature is not taken. Heat stroke is defined when body temperature exceeds 41°C (106°F) along with absence of sweating and altered sensorium.

Mistake No. 2
Heat stroke mistaken for heat exhaustion: The two can be differentiated, as in heat stroke there is no sweating.

Mistake No. 3
Gradual lowering of temperature: The goal of treatment should be to reduce the temperature by at least 0.20C/minute to approximately 39°C (102°F).

Mistake No. 4
Continuing active external cooling beyond 39°C: The cooling should be halted at 390C to prevent over shooting leading to hypothermia.

Mistake No. 5
Giving anti fever medicines: Anti fever medicines like paracetamol, aspirin and other non-steroidal anti-inflammatory agents have no role in heat stroke. They may in fact be harmful if the patients have underlying liver, blood and kidney damage. They may also cause bleeding.

Mistake No. 6
Not checking temperature continuously: One should ideally place a flexible indwelling thermistor rectally to continuously monitor temperature.

Mistake No. 7
Not checking fever once temperature settles down: Thermal instability may persist for a few days after the onset of heat stroke. Therefore, temperature must be continuously monitored during this period.

Mistake No. 8
Not removing restrictive clothing: All clothes should be removed so that temperature can be lowered by evaporation.

Mistake No. 9
Giving Phenytoin during seizure: Phenytoin is not effective in controlling seizures in heat stroke.

Mistake No. 10
Giving chlorpromazine to lower temperature: Chlorpromazine was the main stay of therapy in the past, but is now avoided as it increases chances of seizures.

Mistake No. 11
Patients on anti cholinergic and anti histaminic drugs: In this season, self-treatment with anti allergic and anti nasal discharge drugs can be harmful. They lead to impaired heat loss and precipitate hypothermia.

Mistake No. 12
Heart patients not taking precautions: In elderly heart patients, cardiovascular drugs like beta blockers, calcium channel blockers and diuretics may interfere with cardiovascular response to heat, heat loss and precipitate hyperthermia.

Mistake No. 13
Not realizing that the patient may be on substance abuse: Stimulant drugs, including cocaine and amphetamines can generate excessive amount of heat by increasing metabolism. They can worsen heat stroke.

Mistake No. 14
Ignoring mild temperature: One should remember that high temperature would be reached only if mild temperature is ignored.

Mistake No. 15
Not giving enough fluids: Remember the internal organs are on fire and the fires can only be extinguished with fluids. Such patients need liters of intravenous fluids to manage their internal fire.

Mistake No. 16
Doing sponging only on the head: The patients require continuous sponging of the body with tap water and not restricting to only the armpits or head. Some doctors even try to immerse the patient in water. Ice massage should be avoided as it does not lower the internal core temperature.

    eMedinewS Special

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  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

    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

from Sept 29, 2011: 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 Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr Rajiv Parakh, Dr Sudhir Gupta