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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


eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

  Editorial …

14th October 2011, Friday

Do not give Clopidogrel Aspirin combination for preventing strokes

The US FDA has stopped a study examining if a combination of clopidogrel and aspirin could help prevent subcortical strokes. The National Institute of Neurological Disorders and Stroke made the decision after determining that patients taking the combination were at a higher risk of bleeding events and death. For stroke the combination does not offer any protection, but does put one at increased risk for bleeding.

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

Do not give Clopidogrel Aspirin combination for
preventing strokes

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

MTNL Perfect Health Mela 2010

Divya Jyoti - An Inter Nursing School + College Health Festival. Nurses are the backbone of any medical services and need to be educated about all aspects of health.

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


India polio-free? No case since Jan 13

NEW DELHI: India has not reported a single polio case in over 200 days. The country's only polio case reported this year was on January 13 from West Bengal. India has been alert to any sort of import of the virus from neighbouring countries too. The Global Polio Eradication Initiative (GPEI) says 11 countries are facing outbreaks owing to the import of the polio virus. Pakistan is reeling under a polio outbreak (over 100 cases) following the transmission of the P1 strain, and is the only Asian country this year to have reported the P3 virus, which is on the verge of elimination elsewhere on the continent. (Source: TOI, Oct 12, 2011)

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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)

Some diabetes teaching programs better than others

Educational interventions can improve glycemic control in patients with uncontrolled diabetes, although some strategies are more effective than others, researchers found. Individual education had an advantage over a group program and behavioral intervention was superior to both group and individual standard education, according to three randomized controlled trials reported online in Archives of Internal Medicine. (Source: Medpage Today)

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Effect of metformin therapy on vitamin D and B12 levels in patients with type 2 diabetes

A retrospective chart review of patients treated between 2003-2009 at Loyola University Medical Center in both ambulatory primary care and endocrinology clinics confirms the higher prevalence of vitamin B12 deficiency in metformin treated type 2 diabetic patients. This study also suggests that vitamin D deficiency is not a clinical concern among metformin treated type 2 diabetics, and metformin does not negatively impact treatment of vitamin D deficiency in these patients. (Source: Endocr Pract. 2011 Sep 22:1-16. Epub ahead of print)

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'Black Death' genome analysis shows links alive today

Reconstruction is complete on more than 99% of the genome of the Yersinia pestis strain responsible for the plague that swept Europe in the mid-14th century, killing nearly half of the population, an international team of researchers reported. A phylogenetic analysis of the reconstructed genome revealed that the plague pathogen is just two substitutions away from the common ancestor of all modern strains of Y. pestis, Johannes Krause, PhD, of the University of Tübingen in Germany, and an international team of colleagues wrote online in Nature. "It's extremely closely related" to strains circulating today, Krause said on a Tuesday conference call with reporters. The work of Krause and colleagues marks the first time an historical pathogen has been reconstructed from skeletal remains -- in this case from Black Death victims interred at the East Smithfield mass burial site in London from 1348 to 1350. (Source: Medpage Today)

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   Twitter of the Day

@DrKKAggarwal: #AJPP Breast–feeding linked to higher 14–month mental development Breast–feeding is linked to higher mental...fb.me/VHbHvIwx

@DeepakChopra: #CosmicConsciousness Black holes suck

    Spiritual Update

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

Spiritual Significance of Lighting a Lamp in Any Worship?


Deepajyothi parabrahma
Deepa Jyotir Janaardanah
Deepo harati paapaani
Sandhyaa deepa namostute ||

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   An Inspirational Story

(Ms Ritu Sinha)

Life and Love's unending journey

Love should always remain hopeful and positive in the difficult journey that follows along lives "bumpy detours and highways". Love should never lead dreamers astray, left to stumble and stammer along the "narrow muddy paths" of unfulfilled love, nor leave them alone to pass the dark and shadowy graveyards on the "lonely boulevards" of broken hearts, strewn with unkept promises and shattered dreams of "what was to be".

Love should always be alert and avoid the uncompromising gray sidewalk of the "two way street" of opposite direction and conflict and seek the sunny "one way street" of like attraction, goals, aims, purposes and desires.

So always drive on the "high road" on life's golden carpet down the "yellow brick road" to love and life's grand "promenades" and elegant "thoroughfares," leaving together to follow and smell the sweet scents and fragrances that waif and rise to greet and linger in the air.

For comments and archives

    Fitness Update

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

Diabetes susceptibility gene identified: Tomosyn-2 regulates insulin secretion

A group of researchers from the University of Wisconsin-Madison has pinpointed a gene that confers diabetes susceptibility in obese mice. Published in the open-access journal PLoS Genetics, this study also shows that its protein tomosyn-2 acts as a brake on insulin secretion from the pancreas. "It's too early for us to know how relevant this gene will be to human diabetes," says Alan Attie, who leads the group, "but the concept of negative regulation is one of the most interesting things to come out of this study and that very likely applies to humans."

In a properly tuned system, insulin secreted into the blood after eating helps maintain blood sugar at a safe level. Too little insulin (as in type 1 diabetes) or insulin resistance (as in type 2 diabetes) leads to high blood sugar and diabetic symptoms. Too much insulin can drive blood glucose dangerously low and lead to coma or even death. The group found tomosyn-2 while searching for genes that contribute to diabetes susceptibility in obese mice. Genetic analyses and comparisons of obese diabetes-resistant and diabetes-susceptible mouse strains revealed a single amino acid difference that destabilizes the tomosyn-2 protein in the diabetes-resistant mice, effectively releasing the brake on insulin secretion and allowing those animals to release enough insulin to avoid diabetes.

For comments and archives

    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What the National Drug Policy of India says

What is the treatment of mixed infections (P. vivax + P. falciparum cases)?

All mixed infections should be treated with full course of Artemisinin-based combination therapy (ACT) and primaquine 0.25 mg per kg body weight daily for 14 days.

For comments and archives

    Medicine Update

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

Should genotype testing be done on all chronic hepatitis B?

Recent data suggest that the HBV genotypes may play an important role in the progression of HBV–related liver disease as well as response to interferon therapy. Studies from Asia found that HBV genotype B is associated with HBeAg seroconversion at the earlier age, more sustained remission after HBeAg seroconversion, less active hepatic necroinflammation, a slower rate of progression to cirrhosis and a lower rate of HCC development compared to genotype C. Another study of peg IFN– reported that genotype A but not genotype B was associated with a higher rate of HBeAg seroconversion. Studies of nucleoside analogue therapies have not shown any relation between HBV genotypes and response. Thus, additional data on the relation between HBV genotypes and treatment response are needed before testing for HBV genotypes in clinical practice is recommended.

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

T3 uptake

This test measures the amount of thyroxine–binding globulin (TBG) in the patient’s serum. When TBG is increased, T33 uptake is decreased, and vice versa. T3 uptake does not measure the level of T3 or T4 in serum.

  • Increased T3 uptake (decreased TBG) in euthyroid patients is seen in chronic liver disease, protein–losing states, and with use of the following drugs: androgens, barbiturates, bishydroxycourmarin, chlorpropamide, corticosteroids, danazol, d–thyroxine, penicillin, phenylbutazone, valproic acid, and androgens. It is also seen in hyperthyroidism.
  • Decreased T3 uptake (increased TBG) may occur due to the effects of exogenous estrogens (including oral contraceptives), pregnancy, acute hepatitis, and in genetically–determined elevations of TBG. Drugs producing increased TBG include clofibrate, lithium, methimazole, phenothiazines, and propylthiouracil. Decreased T3 uptake may occur in hypothyroidism.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

India’s sex ratio is very low, next only to China. Girls are eliminated selectively at various levels. The PNDT Act has failed to improve the sex ratio. What other legal approach can be taken?


  1. Low sex ratio does not have its root cause in the ultrasound machine. It was low even before ultrasound became common. All that the ultrasound has done is to hasten a pre-existing trend. Banning ultrasound cannot banish the pre-existing trend.
  2. Even without ultrasound, several techniques have been used in the society for centuries to eliminate the girl child. Some of these are as follows:
    a. Physically smothering the baby girl at birth;
    b. Letting her choke on milk/water poured in her mouth
    c. Burying her alive in the ground or throwing her in a pond etc.
    d. Chronic deprivation of the girl child from food, nutrition, medicines etc.
  3. The root causes of female killing are: poverty; lack of security as regards crimes against women; a girl is seen as an economic burden, especially when viewed in the context of dowry. All these basically converge into a single attribute—Non-empowerment of women/low socioeconomic status of women.
  4. If sex ratio has to be improved, the root causes need to be addressed, rather than focus all attention upon restricting the use of ultrasound. Measures to raise the social status and empowerment of women on a war footing can yield effective results within one generation.
  5. Some of the legal and administrative measures that can be taken to improve sex ratio are as follows:
    a. The goal of 100% female literacy (defining literacy as education up to primary school) should be achieved at whatever cost by whatever means. It must be remembered that education is the best means of empowerment. If necessary, specific central or state laws should be made for this purpose. The performance of states and districts as regards achievement of this time bound goal should be strictly monitored and bottlenecks removed; incentives given; and, disincentives/punishment imposed.
    b. The PNDT Act should be scrapped or radically altered to provide for the following:
    i. It should be recognised that ultrasound is a very useful investigation for a large number of disease conditions and its free use, including 3-D and 4-D ultrasound, should be encouraged rather than suppressed.
    ii. There should be no restriction on doing USG or buying an ultrasound machine.
    iii. There should be no restriction on doing USG in pregnancy.
    iv. The following specific measures should be adopted:

    ONE--Every person performing a USG on a pregnant woman and reporting the sex as female should be promised Rs. 2000/-, payable on delivery of the female child.

    TWO--Every woman carrying a female fetus should be promised the following:

    FIRSTLY--A reward of Rs. 5000/-, payable on delivery of the female child.

    SECONDLY--Immediate preferential Adhar/UID registration of the whole family (with consequential benefits) on USG diagnosis of the female sex of the child.

    THIRDLY--Immediate FREE one year special mediclaim policy for the mother which would provide complete health cover (including the pregnancy related cover), the insurance expenses being borne by the government. This one year policy should also cover the baby, in-utero as well as ex-utero, for a period of 365 days commencing from the date of the policy.

    FOURTHLY--A special FREE LIC policy for the girl child from birth till the age of 18 years.

    FIFTHLY--A monthly cash allowance of Rs. 1000/- for the female fetus/girl child till she attains the age of 18 years.

    SIXTHLY--FREE education for the girl up to whatever level she wants to study.

    c. The bill for one-third reservation of women in legislatures/Parliament should be passed without delay. This will be a step towards empowerment of women.
    d. The following recommendation of the Law Commission in its Report dated 2008 should be implemented by the Centre without delay:

    “(i) A “Marriage and Divorce Registration Act” [hereinafter referred to as the “proposed law”] should be enacted by Parliament, to be made applicable in the whole of India and to all citizens irrespective of their religion and personal law and without any exceptions or exemptions.”

    Such an Act will go a long way in empowering women and reducing crimes against them.

    e. The compulsory registration of pregnancies, as conceptualised in India’s National Population Policy, 2000, should be implemented. This will ensure monitoring of pregnancies and will help in identifying and avoiding attempts at selective female foeticide.
    f. The income tax law should be amended to provide the following:

    i. Further increase substantially the relief in income tax in case of women;
    ii. A legal provision to recognise housekeeping as a legitimate activity for the purpose of income tax, providing thereby that one-fourth of the husband’s income (with a certain maximum limit) would be deemed to have been paid to the wife towards the service of housekeeping. This amount paid should be treated as the wife’s independent non-taxable income. (Suitable provisions would need to be included where the main earning spouse is the wife and house-keeping is done mainly by the husband).

    g. Investigation and trial related to crime against women should be fast paced in a time bound manner by taking necessary measures.
  6. 100 worst districts as regards sex ratio should be identified and subjected to more intense funding, monitoring and evaluation etc. aimed at bringing them at par with the remaining districts within a specified period.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient had a break of policy for two days.
Dr. Bad: You will have to go for new policy now. Dr. Good: Your old policy should be continued.
Lesson: Cumulative bonus provisions are applicable only in respect of continuous insurance without break excepting, however, in exceptional circumstances, the break in period for maximum of seven days is approved as a special case subject to medical examination and explanation of diseases contracted during the break period.

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Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Yet it is in our idleness, in our dreams, that the submerged truth sometimes comes to the top. Virginia Woolf


Pick up your ears: To listen very carefully.

    Mind Teaser

Read this…………………

Treatment of choice for gastric varices is

a) Sclerotherapy
b) Band Ligation
c) Transjugular Intrahepatic Portosystemic Shunt
d) Application of cyanoacrylate glue
e) Shunt surgery

Yesterday’s Mind Teaser: Which of the following statement is correct regarding systemic treatment of early stage breast cancer?

1. Aromatase inhibitors are standard adjuvant hormone therapy in premenopausal women.
2. Adjuvant chemotherapy is beneficial only in ER/PR negative breast cancer.
3. More than 80 percent of breast cancers overexpress HER2 protein and can be treated with trastuzumab.
4. Adjuvant chemotherapy benefits both premenopausal and postmenopausal women.

Answer for yesterday’s Mind Teaser: 3. Previous radiation therapy to the breast is not a contraindication to breast conservative approach.

Correct answers received from: Dr Surendra Bahadur Mathur, Dr Prabha Sanghi, Muthumperumal Thirumalpillai, Dr K Raju, Dr Prof HL Kapoor, Dr Mayur Gunderia, Dr Jainendra Upadhyay, Neelam Nath, Anil Bairaria.

Answer for 12th October Mind Teaser: B. Heart disease
Correct answers received from: Chhabra HS, Dr Rakesh Bhasin, Dr AK KELA.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Prabha Sanghi)

An elderly lady is on the witness stand in a small town courtroom. The prosecutor asks her if she knows the defense attorney and she says,"Yes, I do. He's a drunkard. He's never sober. I've known him all his life." The defense attorney asks her, "Maam, do you know the prosecutor?' She answers, " Yes, I do. He's a cheat. He cheated all through school. He cheated on the bar exam and he cheats on his wife." The judge asks both lawyers to approach the bench. He says, "If either one of you asks that old woman if she knows me, you're both going to jail for a year."

    Medicolegal Update

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

Doctor should always document the resuscitative/surgical injuries in case of death of a medico-legal case

The site of rib fractures after heavy blunt thoracic injuries was preferably found in the dorsal region

Doctors must have a complete understanding and clarity about the methods, indications and duration of resuscitation used in a particular case and whether all these have been documented in the clinical sheets or not. Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries. The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

The injuries produced in human body when attempting for resuscitation pose difficulty in interpretation of injuries noted at post mortem examination or in inquest paper by the investigating law enforcement agency. Before proceeding to make an interpretation, the doctor conducting the autopsy should know if there has been an attempt for resuscitation and who did it and for how long.

  • The method generally used for life saving attempts by non-medical persons who are with the critical patient is mouth-to-mouth respiration and manual chest massage which may causes contusions.
  • Bag and mask intubations, endotracheal tube, obdurate airway are used for respiratory ventilation.
  • The mechanical methods like thumper, active compression-decompression device and defibrillators are used in resuscitation. The closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
  • Injections, closed-chest cardiac massage and other resuscitation procedures to the patients may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral hemothorax, tension pneumothorax, rupture of kidney and spleen.
  • The site of rib fractures after heavy blunt thoracic injuries was preferably found in the dorsal region.
  • The injuries which are received/inflicted on body prior to death are called mortem injuries and may or may not be a contributing factor in causing the death or they may have occurred due to much other reason like resuscitation/transport of sick/ill person for medical care called artifact

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    Public Forum

(Press Release for use by the newspapers)

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

Dandiya Show in MTNL Perfect Health Mela

On Sunday 16th October, 2011 at Garden of Five Senses a special Dandiya Show will be organized as a part of MTNL Perfect Health Mela being organized by Heart Care Foundation of India and World Fellowship of Religions in association with Health Department, Government of Delhi.

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Perfect Health Mela said that the Dandiya Show will be dedicated on the subject “Save the girl child”. Over 2000 members of the public will participate for a Dandiya Show. There is no entry fee for the Dandiya Show.

Dr. Aggarwal said that the Mela is being organized by Heart Care Foundation of India and World Fellowship of Religions jointly with Health Department, Government of Delhi, MCD and NDMC from October 14 to 23, 2011.

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    Readers Responses
  1. Dear KK, Fully agree with your editorial that giving appointments for crucial tests with an unreasonable wait period is counter productive. Thes tudy does not mention the number of patients who are able to jump the queue using means fair and foul.With best wishes,Yours sincerely,Anuj Sinha.
    Forthcoming Events

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

for complete programme details

Dr K K Aggarwal

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