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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 …

16th February 2013, Saturday

Pain Management

  • Pain is a common occurrence in day to day life and should be managed well.
  • Remember the word ‘ICE’ which means putting ice pack on the injured painful area, ‘C’ stands for compression and ‘E’ stands for elevation.
  • The mantra, therefore, is to use cold compression and elevation for any injury.
  • Alternate hot and cold packs are used for chronic pain.
  • Painkillers should not be taken without a doctor’s advice.
  • If a painkiller has to be taken, it should one tablet of paracetamol.
  • People who take alcohol should not consume paracetamol without asking their doctor.
  • In patients with kidney disease, even one tablet of painkiller can precipitate kidney failure.
  • In patients with acid peptic disease, one tablet of painkiller can precipitate gastric bleeding.
  • Instead of taking a painkiller, look for alternative methods to relieve pain.
  • Pain relieving ointments are better than oral painkillers.
  • In hospital setting, intravenous and intramuscular injectable painkillers are available.
  • Always tell your doctor that you are taking painkillers.
  • There are effective pain management therapies available in homeopathy and Ayurveda.
  • Always contact your doctor if the pain is uneasy, unexplainable or appears for the first time in life.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

How do bowel patterns influence management of constipation?

Most patients who have a normal bowel pattern usually empty stools at approximately the same time every day. This fact suggests that the initiation of defecation is in part a conditioned reflex. Colonic motor activity is more active after waking and after a meal. Thus, the optimal time for bowel movement is usually within the first two hours after waking and after breakfast. Timed toilet training consists of educating patients to attempt a bowel movement at least twice a day, usually 30 minutes after meals, and to strain for no more than five minutes.

For comments and archives

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

White rice linked to diabetes in Asians

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2013

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

Air pollution fifth leading cause of death in India: Study

NEW DELHI: Air pollution is the fifth leading cause of death in India after high blood pressure, indoor air pollution, tobacco smoking and poor nutrition, with about 620,000 premature deaths occurring from air pollution-related diseases. Like China, India faces an unprecedented public health crisis due to air pollution, the Centre for Science and Environment's (CSE) analysis of government data and the Global Burden of Disease report's data on India has shown. The green think tank released its own assessment and the global study's India specific data on Wednesday warning that the number of premature deaths due to air pollution had increased six fold over the last 10 years. Air pollution is now the seventh leading cause behind the loss of about 18 million healthy years of life in India due to illness. It comes after indoor air pollution, tobacco smoking, high blood pressure, childhood underweight, low nutritional status, and alcohol use. CSE's own assessment of the air pollution data generated by the government painted the grim facts that are leading to the public health crisis. "Close to half of cities are reeling under severe particulate pollution while newer pollutants like nitrogen oxides, ozone and- air toxics are worsening the public health challenge," CSE estimates say. Half of the urban population breathes air laced with particulate pollution that has exceeded the safety standards. As much as one third of urban population is exposed to critical level of particulate pollution. Smaller cities are among the most polluted in the country. The data is a damning indictment of India's supposed growing urban regions. Out of the 180 cities that are monitored for only two towns — Malapuram and Pathanamthitta — in Kerala meet the low pollution norms (pollution levels remaining at 50% below the standard) for all pollutants. About 78% cities (141 cities) exceed the standard set for particulate matter of size below 10 microns (PM10). As many as 90 cities have critical levels of PM10 and of this, 26 cities have most critical levels of PM10, exceed the standard by more than 3 times. Gwalior, West Singbhum, Ghaziabad, Raipur, and Delhi are top five critically polluted cities. (Source: TOI, Feb 14, 2013)

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)


Categories of emotional or psychological abuse

  • Corrupting– Stimulating destructive, antisocial, or sexually exploitative behavior, reinforcing deviant behavior
  • Verbal assault or spurning– Name-calling; sarcasm that erodes the child's self-esteem and reinforces negative self-image; singling out a child to criticize or punish; humiliating the child in public.
  • Over pressuring– Overly advanced expectation of the child's behavior and accomplishments; criticism of age-appropriate behavior as inadequate; comparing the child's behavior to other children as "poor by comparison," resulting in a negative self-image and behavior disturbance. (Source: Uptodate)

For comments and archives

    Valvular Heart Disease Update

What is the indication of surgery in a patient with chronic mitral regurgitation?

One or both of the following criteria for LV dysfunction is sufficient to warrant mitral valve surgery in the 2006 ACC/AHA guidelines and the 2007 ESC guidelines:

  • An LVEF=60 percent
  • An LV end–systolic dimension=40 mm (ACC/AHA) or >45 mm (ESC)

(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)

SPS3: Lower blood pressure reduces recurrent stroke

Lowering systolic blood pressure to below 130 mm Hg probably reduces stroke risk by almost 20% in patients who have already had a stroke, researchers conclude from a new study. (Source: Medscape)

Antiplatelet duo helps after minor stroke

In the months immediately after a minor stroke or transient ischemic attack (TIA), adding clopidogrel to aspirin therapy cuts the risk of another stroke, a Chinese trial showed. (Source: Medpage Today)

FDA approves retinal prosthesis, a 'Bionic Eye'

The US Food and Drug Administration (FDA) gave marketing approval Thursday to a retinal prosthesis that can enable blind people with advanced-stage retinitis pigmentosa (RP) to avoid obstacles in their path and read large letters. The Argus II Retinal Prosthesis System (Argus II) will not restore normal vision to patients with RP, according to the device’s maker, Second Sight Medical Products Inc, Sylmar, California. Instead, it produces patterns of light that the brain learns to interpret as specific objects in the environment. Source: Medscape)

Rapid BP lowering safe in ICH

Rapid blood pressure lowering in patients with intracerebral hemorrhage is safe and does not compromise cerebral blood flow, according to new findings from the Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT). (Source: Medpage Today)

Home-based exercises may protect high-risk elderly women from hip fractures

Home-based exercises may protect high-risk elderly women from hip fractures, according to the results of a population-based, randomized controlled exercise trial reported in the September 27 issue of the Archives of Internal Medicine. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Drinking Coffee Prevents Parkinson’s disease http://bit.ly/12Q0ziU #Health

@DeepakChopra: How would you deal with things you "can't control in life"? PLease take a look at my #askdeepak reply http://tinyurl.com/aaf2zqa

    Spiritual Update

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

Vasant Panchami

Vasant or Basant or Shree Panchami is a Hindu festival celebrating Saraswati, the goddess of knowledge (wisdom, learning), music and art and is celebrated every year on the fifth day (Panchami) of the Indian month Magh (January-February) and marks the first day of spring.

For comments and archives

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

How do androgens affect our hair growth?

Androgens are present in both men and women, but men have much higher levels. In men, androgens are produced primarily by the testes and the adrenal glands. In women, androgens are produced by the ovaries and the adrenal glands. To some degree, estrogen reduces the effect of androgens in women. If your hair follicles are sensitive, androgens may cause some vellus hairs to change to terminal hairs and cause the terminal hairs to grow faster and thicker. Once a vellus hair has changed to a terminal hair, it usually does not change back. Androgens increase sebum production, which results in oily skin and acne. Excess androgens can cause irregular or absent ovulation and menstruation. Extremely high androgen levels, such as when a tumor is present, may cause male-like balding, deepening of the voice, increased muscle mass, enlargement of the clitoris, and decreased breast size.

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

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

Blood and blood components are vital to the health care system of a country

Patients with thalassemia, hemophilia, anemia and leukemia require regular blood transfusions. Blood is also required in cases of accidents and surgical operations. Obviously, the question arises as to wherefrom all the blood comes and also how are we going to cope up with the load of growing demands and requirements. The only way is to request and motivate more and more of volunteers to come forward and they pour out their small Ahuties in this Maha Yagna of Voluntary Blood Donation Movement.

For comments and archives

    An Inspirational Story

When my fingers grow back?

A man came out of his home to admire his new truck. To his puzzlement, his three-year-old son was happily hammering dents into the shiny paint. The man ran to his son, knocked him away, and hammered the little boy's hands into a pulp as punishment. When the father calmed down, he rushed his son to the hospital.

Although the doctor tried desperately to save the crushed bones, he finally had to amputate the fingers from both the boy's hands. When the boy woke up from the surgery & saw his bandaged stubs, he innocently said, "Daddy, I'm sorry about your truck." Then he asked, "but when are my fingers going to grow back?"

The father went home and committed suicide.

Think about the story the next time you see someone spill milk at a dinner table or hear a baby crying. Think first before you lose your patience with someone u love. Trucks can be repaired. Broken bones & hurt feelings often can't. Too often we fail to recognize the difference between the person and the performance. People make mistakes. We are allowed to make mistakes. But the actions we take while in a rage will haunt us forever.

Pause and ponder. Think before you act. Be patient. Understand and love.

For comments and archives

  Cardiology eMedinewS

Lowering BP may cut risk of recurrent stroke Read More

Obesity can cause vitamin D deficiency, genetic study shows Read More

  Pediatric eMedinewS

No long-term benefit of trauma treatments in kids Read More

Vision screening in toddlers flags amblyopia risks 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)

How can rabies virus be inactivated?

Rabies virus is inactivated by the following methods:

  • Heat (1 hour at 50°C)
  • Exposure to ultraviolet radiation
  • Exposure to 70% ethanol, phenol, formalin, ether, trypsin, ß-propiolactone
  • Detergents
  • Lipid solvents
  • At pH below 3 or above 11
  • Ultra-violet and x-rays
  • Rabies virus is inactivated rapidly in sunlight and does not survive for long periods outside the host (in dried blood and secretions) as it is susceptible to sunlight and desiccation
    IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine and palpitations came for treatment.
Dr. Bad: No drug is needed.
Dr. Good: Take verapamil.
Lesson: Verapamil is frequently used as a first choice for preventive migraine therapy because it is easy to use and has fewer side effects.

Make Sure

Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with LVOT obstruction are not given sublingual nitrates.

  Quote of the Day (Dr GM Singh)

If I had a rose for every time I thought of you, I'd be picking roses for a lifetime. Swedish Proverb

    Mind Teaser

Read this…………………

A 45-year-old male patient reports pain in his foot that moves up along his calf. The patient states, "My right foot feels like it is on fire." The patient further describes that he has no previous history of injuries or falls, and that his pain started yesterday. Which components of pain assessment has the patient reported?

a. Aggravating and alleviating factors
b. Exacerbation, and associated signs and symptoms
c. Intensity, temporal characteristics, and functional impact
d. Location, quality, and onset

Yesterday’s Mind Teaser: When assessing a patient for possible side effects related to acetaminophen (Tylenol), the pain management nurse asks the patient about the use of:

1. Alcohol
2. Marijuana
3. Opioids
4. Tobacco

Answer for Yesterday’s Mind Teaser: Alcohol

Correct answers received from: Dr Deepali Chatterjee, Dr Ajay Gandhi,
Dr Bharat Bhushan Aggarwal, Dr Raghavendra Jayesh, Dr PC Das, Dr Kanta Jain, Dr K Raju, Dr Thakor Hitendrsinh G, Dr (Maj. Gen.) Anil Bairaria, Dr Arpan Gandhi, Dr KV Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Bharat Bhushan Aggarwal, Dr Bharat Bhushan Aggarwal, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 14th February Mind Teaser: b. Home remedies used to treat pain

Correct answers received from: Dr Bharat Bhushan Aggarwal, 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)

An angry wife was complaining about her husband spending so much time at the pub, so one night he took her along. "What'll ya have?" he asked. "Oh, I don't know. The same as you, I suppose," she replied.
So the husband ordered a couple of Jack Daniel's and threw his down in one gulp. His wife watched him, then took a sip from her glass and immediately spit it out.
"Yuck, that's nasty poison!" she spluttered. "I don't know how you can drink this stuff!" "Well, there you go," cried the husband. "And you think I'm out enjoying myself every night!"

    Medicolegal Update

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

Antemortem vs postmortem injury

  • The injuries which are received in the body prior or before death is called the antemortem injury in medicine. These injuries may be a contributing factor in the death or even its cause however on the other hand, they may have occurred many days/months or years ago too.
  • During the autopsy, surgeon assesses the age of antemortem injuries, as well as distinguishes them from postmortem injuries, which occur after death. Postmortem injury can be from various sources such as deliberate mutilation of a body by a murderer following a homicide, predation by wild animals, or careless handling in the mortuary. Postmortem injuries can cause confusion over the manner and cause of death.
  • One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed. After death, the body usually does not bleed. However, there are exceptions. For instance, when a person drowns, their body usually floats face down and these results in the head becoming congested with blood.
  • Careless handling of a cadaver may produce some post-mortem bruising which may need to be distinguished from ante mortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as discoloration. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with antemortem bruising.
  • If the cadaver receives a head injury by colliding with blunt object/force, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood. It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration to the head and scalp which may be very hard to interpret.
  • Recent research has focused on improved techniques for distinguishing between an ante mortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Some research suggests that tissue from ante mortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help in more accurate assessment of injuries.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Kidney stone of less than 5mm size needs no treatment

A stone less than 5mm in size, in the kidney passage, should not be treated as it will invariably pass out in the next four weeks, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

A stone between 5 to 10 mm has only 20% chances of passing spontaneously. A stone that is more than 10mm size invariably requires a non-medical intervention.

Dr. Aggarwal said that new avenues in stone management include a trial by drugs, which help in expulsion of the stone by relaxing the smooth muscle. The drugs used are nifedipine (calcium channel blocker), alpha-blockers and steroids.

Intravenous pyelography has been thought to be the best investigation for renal stone. But now it has been proven beyond doubt that when a patient presents with kidney pain and if a renal stone is suspected, the undisputed investigation of choice is unenhanced CT scan of the abdomen. Open removal of stones is no more recommended. Lithotripsy, PCNL and ureteroscopy have practically taken over from the open surgical procedures.

North India is considered a stone belt, with maximum cases of kidney stones in India.

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 29209 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.”

    Readers Response
  1. Dear Sir, emedinews is very informative. Regards:Dr Tripti
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