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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

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  Editorial …

16th March 2013, Saturday

15 ways to reduce or stop drinking

If you are dependent on alcohol, or have other medical or mental health problems you should stop drinking completely. Reduction of heavy drinking may be a more acceptable goal for some patients who lack readiness to quit drinking.

The frequency of heavy drinking (more than 5 drinks per day for men and 4 for women) has the highest correlation with negative life consequences such as impaired driving, interpersonal problems and injuries.

You need to cut down if in the past one year you have taken one or more times, more than 5 drinks in a day (4 drinks for women). This positive response to a single question “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, is recommended for use by the National Institute on Alcohol Abuse and Alcoholism. The sensitivity and specificity of this question is 81.8 and 79.3 percent, respectively.

One can also know the dependence of alcohol by using the CAGE questionnaire.

  1. Have you ever felt the need to Cut down on drinking?
  2. Have you ever felt Annoyed by criticism of your drinking?
  3. Have you ever had Guilty feelings about your drinking?
  4. Do you ever take a morning Eye opener (a drink first thing in the morning to steady your nerves or get rid of a hangover)?

One positive response to any question suggests need for closer assessment; two positive responses are seen in the majority of patients with alcoholism. Two positive responses have a sensitivity of 77 percent and specificity of 80 percent in patients with alcohol dependence. Over 80 percent of nonalcoholic patients have a negative response to all four questions and virtually none has a positive response to more than two questions.

National Institute on Alcohol Abuse and Alcoholism suggests the following for stopping or reducing alcohol:

  1. Put it in writing why you want to reduce or stop: Write what you want to achieve, for example, will feel healthier; will sleep better, will improve my relationships.
  2. Write confessions: learn and practice various confession exercises. This will help you take care of inner guilt which may be the precipitating factors.
  3. Set a drinking limit: Those who are cutting back should set a limit as per your health. Most healthy people should limit to less than 40 ml in one hour, 80 ml in one day and less than 240 ml in a week. Women should take less than half of this amount.
  4. Keep a diary of your drinking. For initial 3-4 weeks, keep track of every drink. Note the situations you are most likely to drink. Give each situation a rating out of ten. Try avoiding those situations for the next few weeks.
  5. Don’t keep alcohol within your reach. Remove alcohol from your living place. This can help limit drinking.
  6. Eat your drink. Drinking slowly can help. Sip and do not gulp. Sip soda, water, or juice after each drink. This is called Mindful drinking. If you are aware of your drinking, you will cut back on it. Otherwise, you will drink more.
  7. Never drink on an empty stomach.
  8. Keep weekly one or two spiritual fast/s. This will allow alcohol-free days. Decide not to drink a day or two each week.
  9. Observe spiritual retreats: Observing spiritual retreats (Navratri by Hindus, Ramzan by Muslims, and Easter by Christians) with no drinking can help. Or try abstaining for a week or a month to see your commitment to not drinking.
  10. Become a tortoise: Learn to withdraw yourself from all stimuli which can force you to drink.
  11. Watch for peer pressure. Learn to say no. Do not drink just because others are, and you shouldn’t feel obligated to accept every drink you’re offered. Stay away from people who encourage you to drink.
  12. Keep busy. Take a walk, play sports, go out to eat, or catch a movie. When you’re at home, pick up a new hobby or revisit an old one. Painting, board games, playing a musical instrument, woodworking — these and other activities are great alternatives to drinking.
  13. Ask for support. Let friends and family members know that you need their support.
  14. Guard against triggers. Stay away from people and places that make you want to drink. In Yoga it is called Pratahyara and means staying away from the external stimuli. Lust cannot be removed by staying in a lustful atmosphere.
  15. Be persistent. Most people who successfully cut down or stop drinking altogether do so only after several attempts.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

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

FDA OKs first drug-eluting stents for use in MI

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

CPR10 camp at Spring Days Public School

CPR camp was held at Spring Days Public School, Ashok Vihar Phase 1 on 13th March 2013

Dr K K Aggarwal
    National News


Navin C. Nanda, M.D., professor of medicine and director of the echocardiography laboratories at the University of Alabama at Birmingham (UAB), has been named chairman of the Cardiology/Lipid Initiative Committee of the American Association of Physicians of Indian Origin (AAPI). Dr Nanda was president of AAPI for the 1989-1990 term.

National Workshop of transplant coordinators provides guidelines

New Delhi: A high level workshop that included international and Indian stakeholders from the field of organ transplantation met in Delhi from February 28 to March 2, 2013, to discuss ways to increase the deceased donation rate and help overcome organ shortage. The topics covered in the programme ranged from the role of the Government organizations, hospitals and NGOs in the establishment of the deceased donor programme in a hospital and the medico-legal aspects related to the Transplantation of Human Organs Act 1994 (THOA 1994) and its amendments. Specific stress was laid on practical training by conducting counselling, public education programmes, and documentation related to organ donation and transplantation. Dr. Jagdish Prasad, Director General, DGHS inaugurated the workshop and gave the key note address. He congratulated the stakeholders and assured them of his full support in giving a boost to the deceased donation programme. He emphasized the need for public awareness and training the intensive care physicians across the country. Dr. Francis Delmonico, president-elect, The Transplantation Society, who presided over the function, said that transplant coordinators in India could become pioneers in creating an Asian Transplant Coordinators’ Organisation just like the one in Europe. Dr Marti Manyalich, president, Donation and Transplantation Institute, Barcelona, emphasised the need for propagation of the Deceased Donation Pathway and Brain Death audits in all ICUs of hospitals registered as transplant or retrieval centres. The three day workshop after deliberating on various aspects of deceased donation came out with a consensus document of recommendations for the expansion of deceased donation. It was unanimously resolved that the solution to organ shortage and achievement of self-sufficiency in organ donation for all states in India is possible only through systematic strengthening of the deceased donor programme. (Source: The Hindu, March 7, 2013)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)



  1. 4 lakh child CSWs in India
  2. 200 females enter prostitution daily
  3. About 15000 children are reported missing every year
  4. Minimum age for persons trafficked in India has fallen below 10 years 5. Trafficking trade is worth US $ 7 billion annually, next only to the trade of arms and drug trafficking.

For comments and archives

    Valvular Heart Disease Update

Congenital left ventricular outflow obstructive lesions can occur at valvular, sub valvular and supravalvular levels. The most common lesion is bicuspid aortic valve.

(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)

Watching CPR helps ease family's grief

Family members who witnessed a cardiopulmonary resuscitation attempt were less likely to experience subsequent symptoms of post-traumatic stress disorder (PTSD) than those who were not present, a randomized French study by Frederic Adnet, MD, PhD, of Hôpital Avicenne in Bobigny, France, and colleagues wrote in March 14 issue of the New England Journal of Medicine. Some have argued that being present would be associated with an increased emotional burden and other difficulties, not only for the family but also for the emergency medical services team, yet the sole randomized trial looking at this was stopped prematurely because of apparent benefits for families. Despite the lack of evidence, international guidelines today favor family presence during CPR.

For comments and archives

Flu vaccine curbs hospitalization in the elderly

Vaccination can avert well over half of all influenza-associated hospitalizations, according to an effectiveness study by Tennessee-based researchers. (Source: Medscape)

BP drug flops in heart failure

The blood pressure drug aliskiren (Tekturna) doesn't help prevent rehospitalization or death for heart failure patients, the ASTRONAUT trial showed. (Source: Medpage Today)

New assay holds promise as screening tool for kidney cancer

A new immunoassay shows promise as a screening tool for detecting early renal cell carcinoma (RCC). The test measures the levels of 3 biomarkers: nicotinamide N-methyltransferase (NNMT), L-plastin (LCP1), and nonmetastatic cells 1 protein (NM23A). Plasma levels of all 3 were found to be highly elevated in patients with kidney cancer. (Source: Medscape)

Radiation for breast Ca takes toll on heart

Radiation therapy has value in breast cancer, but the benefit comes at the price of an increased risk of ischemic heart disease later, researchers reported. (Source: Medpage Today)

HIV home care increases antiretroviral use

Having the option of home-based antiretroviral therapy after self-testing for HIV led to a 3-fold increase in the uptake of treatment, according to a first-of-its-kind study. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Fears about hypoglycemia and about future complications are major issues for married couples in which one partner... http://fb.me/2uu3F6WFQ

@DeepakChopra: The source of thought is the source of the universe

    Spiritual Update

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

Why do people suffer?

  1. As per Garud Puran and Hindu mythology, one of the reasons for suffering is your past birth's debts. Your purpose of life is to face sufferings to pay these debts.

For comments and archives

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

Should you tell your child or not is the most difficult decision

You and your partner should discuss your personal values, culture, religious beliefs, and those of your community. Using a professional, such as a fertility counselor, in these conversations may be helpful. An important question you must weigh is your right to keep information you believe is private from your child against the child’s right to know the circumstances of his/her conception and genetic origins. You may have difficult emotions about infertility and the fact that you had to rely on a donor to build your family. It's important to resolve these feelings-and your thoughts about a child conceived with the help of a donor-before pregnancy and parenthood.

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

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

Special Sets

High–flow sets for rapid transfusion have large filter surface areas, large bore tubing and may have an inline hand pump. Sets designed for rapid infusion devices may also have "pre–filters" to retain particles over 300 microns in diameter and extend the life of standard blood filters "downstream." Gravity–drip sets for the administration of platelets and cryoprecipitate have small drip chamber/filter areas, shorter tubing and smaller priming volumes. Syringe–push sets for component administration have the smallest priming volumes and an in line blood filter that may be inconspicuous. Filters are not ordinarily used for infusion of commercially prepared plasma products such as albumin, but the manufacturer’s instructions should be consulted for specific recommendations.

For comments and archives

    An Inspirational Story

A Violin with Three Strings

On Nov. 18, 1995, Itzhak Perlman, a violinist, came on stage to give a concert at Avery Fisher Hall at Lincoln Center in New York City.

If you have ever been to a Perlman concert, you know that getting on stage is no small achievement for him. He was stricken with polio as a child, and so he has braces on both legs and walks with the aid of two crutches. To see him walk across the stage one step at a time, painfully and slowly, is an awesome sight.

He walks painfully, yet majestically, until he reaches his chair. Then he sits down, slowly, puts his crutches on the floor, undoes the clasps on his legs, tucks one foot back and extends the other foot forward. Then he bends down and picks up the violin, puts it under his chin, nods to the conductor and proceeds to play.

By now, the audience is used to this ritual. They sit quietly while he makes his way across the stage to his chair. They remain reverently silent while he undoes the clasps on his legs. They wait until he is ready to play.

But this time, something went wrong. Just as he finished the first few bars, one of the strings on his violin broke. You could hear it snap – it went off like gunfire across the room. There was no mistaking what that sound meant. There was no mistaking what he had to do.

We figured that he would have to get up, put on the clasps again, pick up the crutches and limp his way off stage – to either find another violin or else find another string for this one. But he didn’t. Instead, he waited a moment, closed his eyes and then signaled the conductor to begin again.

The orchestra began, and he played from where he had left off. And he played with such passion and such power and such purity as they had never heard before.

Of course, anyone knows that it is impossible to play a symphonic work with just three strings. I know that, and you know that, but that night Itzhak Perlman refused to know that.

You could see him modulating, changing, re-composing the piece in his head. At one point, it sounded like he was de-tuning the strings to get new sounds from them that they had never made before.

When he finished, there was an awesome silence in the room. And then people rose and cheered. There was an extraordinary outburst of applause from every corner of the auditorium. We were all on our feet, screaming and cheering; doing everything we could to show how much we appreciated what he had done.

He smiled, wiped the sweat from this brow, raised his bow to quiet us, and then he said – not boastfully, but in a quiet, pensive, reverent tone – “You know, sometimes it is the artist’s task to find out how much music you can still make with what you have left.” What a powerful line that is. It has stayed in my mind ever since I heard it. And who knows? Perhaps that is the definition of life – not just for artists but for all of us.

Here is a man who has prepared all his life to make music on a violin of four strings, who, all of a sudden, in the middle of a concert, finds himself with only three strings; so he makes music with three strings, and the music he made that night with just three strings was more beautiful, more sacred, more memorable, than any that he had ever made before, when he had four strings.

So, perhaps our task in this shaky, fast-changing, bewildering world in which we live is to make ‘music’, at first with all that we have, and then, when that is no longer possible, to make ‘music’ with what we have left.

For comments and archives

  Cardiology eMedinewS

ACC: BNP screen may halt heart failure Read More

CEA to have doctor-friendly rules in the Act Read More

  Pediatric eMedinewS

CEA to have doctor-friendly rules in the Act Read More

NEET PG Update Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What are the myths about rabies in India?

The following myths about rabies are very prevalent in India:

  • In India, there are many myths and wrong practices concerning the management of an animal bite. People apply turmeric, salt and sometimes ghee over the wound area. Chilies, hydrogen peroxide and cow dung are some other wrong practices followed, mainly in the rural parts of India.
  • Some herbal extracts will cure rabies.
  • In rural areas, people also resort to witchcraft and religious practices.
  • Washing of wound(s) can cause hydrophobia.
  • Dietary changes can cure, i.e., shift from vegetarianism to non-vegetarianism or vice versa; stopping consumption of white things etc.
  • A single dose vaccine will prevent rabies.
  • Vaccines are more effective if taken on empty stomach.
  • One should not bathe or eat meat and eggs during vaccination.
  • Gems and stones have magical properties against rabies.
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    IJCP Special

Dr Good Dr Bad

Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: In neurocysticercosis, the calcification is seen only in the parenchyma and not in ventricles or cisterns.

Make Sure

Situation: An 18–year– old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. A CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

  Quote of the Day (Dr GM Singh)

All cruel people describe themselves as paragons of frankness. Tennessee Williams

    Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. I am an MS (Surgery) and DGO in a semi-urban area. A postgraduate in Ayurvedic surgery here routinely conducts surgeries like hysterectomy, LSCS, fistulectomy and hernia surgery. He has a nursing home where 26 out of the 27 consecutive deliveries were done by caesarean section. Is it legal? If not, what action can be taken?


  • It is not legal because surgery under anesthesia involved use of allopathic drugs but persons not registered with the medical council cannot legally use such drugs and, in using them, they commit quackery in view of the various provisions of the IMC Act, 1956, and IMCC Act, 1970, as reflected in the following judgments:
    • Poonam Verma Vs. Ashwin Patel and Others, decided by the Supreme Court on 10.05.1996, reported as 4 SCC 332, (Kuldip Singh, S. Saghir Ahmad JJ). The judgment can be viewed at-- http://www.indiankanoon.org/doc/611474/
    • Dr. Mukhtiar Chand & Ors. Vs. State Of Punjab & Ors., (1998) 7 SCC 579, decided on 8-1-1998 by judges K.T. Thomas and Syed Shah Mohammed Quadri. The judgment can be viewed at-- http://www.ccimindia.org/downloads/6%20SC%20Judgment%2008.10.pdf
    • Prof. P.N. Thakur v. Hans Charitable Hospital, decided by the national Consumer Commission on 16 Aug. 2007. The judgment can be viewed at—http://ncdrc.nic.in/OP21497.HTML
  • It is outright medical malpractice, if 26 out of the 27 consecutive deliveries are done by caesarean section.
  • The argument, if advanced, that the anesthesia is given by the anesthetist registered with the medical council would not be of help to the Ayurvedic surgeon because, in effect, it is he who is using the allopathic medicines and is dependent on them.
  • The following actions can be taken in this situation:
    • Complaint can be lodged with the SMC / MCI for violation of the relevant Act. IMC Act, 1956, provides one year jail for quackery in terms of section 15.
    • Complaint can be lodged with the consumer court.
    • Complaint can be lodged with the appropriate authority under the CEA or its equivalent Act or some other legal provision in the state. If there is no clear Act or legal provision, complaint can be made to the state health department.
    • WP can be filed in HC against the hospital.
  • The above legal actions should be taken pro-actively by the IMA or other professional associations. It may not be possible for individual doctors to do so.
    Mind Teaser

Read this…………………

Nurse Agnes is reviewing the report of a client’s routine urinalysis. Which value should the nurse consider abnormal?

a. Specific gravity of 1.03
b. Urine pH of 3.0
c. Absence of protein
d. Absence of glucose

Yesterday’s Mind Teaser: A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, Nurse Sarah knows that the client is most likely to experience:

a. hematuria.
b. weight loss.
c. increased urine output.
d. increased blood pressure.

Answer for Yesterday’s Mind Teaser: a. hematuria.

Correct answers received from: Dr PC Das, Rajiv Kohli, Dr Arpan Gandhi, Dr KP Chandra, Dr (Maj. Gen.) Anil Bairaria.

Answer for 14th March Mind Teaser: C. Lung cancer

Correct answers received from: Dr B K Agarwal.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Bosses versus Workers

When I take a long time, I am slow.
When my boss takes a long time, he is thorough.

When I don't do it, I am lazy.
When my boss doesn't do it, he's too busy.

When I do it without being told, I'm trying to be smart.
When my boss does the same, that is initiative.

When I please my boss, that's brown-nosing.
When my boss pleases his boss, that's co-operating.

When I do good, my boss never remembers.
When I do wrong, he never forgets.

    Medicolegal Update

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

Countercoup injury of brain

  • Two types of impact occur on skull and the sound wave elicited by the impact. The first at the site where the force is applied, the second where the advancing segments of the accelerated brain are brought suddenly to rest by the forces that resist its forward motion.
  • Counter coup lesions of the brain were once thought to be caused by the brain moving within the skull in a straight line with the force of the blow striking against its opposite side. But, experiments on mechanics of head injuries have demonstrated these lesions are chiefly due to local distortions of the skull and the sudden rotation of the head as result of a blow, which arouse shear strains or slide produced by the pulling apart of the constituent particles of the brain.
  • Shear strains occur and pull apart the constituent particles of the brain. These are produced in all parts of the brain, but to a large extent at the base of the frontal lobe and the tip of the temporal lobe, as the skull gets a good grip on the brain in this region due to the projecting ridge of the sphenoid bone. Hence, severe and extensive injuries occur in this region with a blow on the occiput.
  • On the other hand, countercoup injuries which are caused by rotation will not occur if the head is so well fixed that it cannot rotate at all when it receives a blow. Cerebral contusions and tears have been reported in autopsy as a result of trauma.

(Ref: Modi’s Medical Jurisprudence, 25th Edition)

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Chocolate, not tea, good for the heart

Regular consumption of polyphenol–rich cocoa products like dark chocolate may be considered a part of dietary approaches to lower BP, provided there is no total gain in calorie intake, said Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA and Dr S Arulrhaj past President Commonwealth Medical Association.

Drug treatment is the basis of blood pressure control, and it should always be accompanied by lifestyle measures such as exercise and proper diet. The recommendation is an occasional cup of cocoa but not chocolate milk, because it is high in sugar and fat.

According to a survey of medical literature by German researcher, Dr. Dirk Taubert from the University Hospital of Cologne, Cocoa–rich products help lower high blood pressure and not tea. They covered 10 studies on cocoa that included 173 participants and five tea studies with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP.

The average reduction was 4 to 5 mm HG in systolic pressure and 2 to 3 mm in diastolic pressure –– enough to reduce the risk of stroke by 20 percent and of coronary heart disease by 10 percent. No such reduction in blood pressure was noted in any of the tea trials, which lasted an average of four weeks. Tea and cocoa contain different kinds of polyphenols –– flavan–3–ols in tea, procyanids in cocoa.

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 31135 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

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