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Dr KK Aggarwal

From the Desk of Editor in Chief
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 ...

16th September, 2010, Thursday

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

Can Ayurvedic Doctors Practice Modern Medicine

Indian System of Medicine – Notification of Ayurveda, Siddha, and Unani Tibb

Registered Medical Practitioners as persons practicing the modern scientific system of medicine under the Drugs and Cosmetics Rules, 1945 – Orders – Issued.

HEALTH AND FAMILY WELFARE (IM 2-2) DEPARTMENT: The following Notification published in the Tamil Nadu Government Gazettee.

NOTIFICATION:  WHEREAS, the rights of practitioners of Indian System of Medicine are protected under section 17(3) (b) of the Indian Medicine Central Council Act, 1970 (Central Act 48 of 1970);

AND WHEREAS, as per section 2 (1) (e) of the said Act, "Indian Medicine" means the system of Indian Medicine commonly known as Ashtang Ayurveda, Siddha or Unani Tibb whether supplemented or not by such modern advances, as the Central Council of Indian Medicine may declare by notification from time to time;  AND WHEREAS, the Central Council of Indian Medicine in its Notification F.No.28-5/2004-AY.(MM), dated the 19th May 2004, has clarified that the word “Modern Advances” in clause (e) of section 2 (1) of the said Act as advances made in the various branches of modern scientific medicine in all its branches of internal medicine, surgery, gynaecology and obstetrics, anesthesiology, diagnostic procedures and other technological innovation made from time to time and declare that the courses and curriculum conducted and recognized by the Central Council of Indian Medicine are supplemented with such modern advances; AND WHEREAS, the Central Council of Indian Medicine has improved and strengthened the syllabus of Indian Medicine by including subjects with regard to National Programmes like National Malaria Eradication programmes, Tuberculosis, Leprosy, Family Welfare Programme, Reproductive and Child Health Programme, Immunisation Programme, AIDS, Cancer etc; Now, THEREFORE, under sub - clause (iii) of clause (ee) of rule 2 of the Drugs and Cosmetics Rules, 1945 the Governor of Tamil Nadu hereby declares every registered medical practitioner holding the qualifications specified in the second, third or fourth Schedule to the Indian Medicine Central Council Act, 1970 (Central Act 48 of 1970) and Part III of the Schedule to the Tamil Nadu Siddha System of Medicine (Development and Registration of Practitioners) Act , 1997 (Tamil Nadu Act 34 of 1997) and registered in the Medical Register of the State maintained under the aforesaid Acts, as a person practicing the modern scientific system of medicine for the purposes of the Drugs and Cosmetics Act, 1940 (Central Act 23 of 1940.)


Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the Net)

Weird X rays (Dr Mukul Tiwai)

X-Ray is one of the most useful medical advancements in history. But they can also reveal some of the most gruesome and bizarre results.
A coloured X-ray of objects swallowed and lodged in the intestine of a patient, including a spoon and a blade.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

In a retrospective cohort study of otherwise healthy children who had an orbital abscess, proptosis, pain with external ocular movement, and ophthalmoplegia were associated with the presence of an orbital abscess, although 51 percent of patients who had an abscess did not have these findings.

(Reference: Rudloe, TF, Harper, MB, Prabhu, SP, et al. Acute periorbital infections: who needs emergent imaging? Pediatrics 2010;125:e719.

  National News

3 Years Course in Emergency Medicine

Moolchand Medcity has started three year post graduate course in Emergency Medicine by George Washington University. The course is post graduate equivalent and a good opportunity for young doctors who want to make successful career in Emergency Medicine.  The Course has limited seats (10). Every year new batch starts from October.  Dr Gayatri Mahindroo,
gayatri.mahindroo@moolchandhealthcare.com, 9810718109

Orissa calls disaster force to tackle cholera

With number of deaths due to diarrhoea and cholera in Orissa’s Kalahandi–Bolangir–Koraput (KBK) districts and more specifically Rayagada district on the rise, the state government on Monday pressed the Orissa Disaster Rapid Action Force (ODRAF), specialised in search and rescue operations during disasters, to bring in patients from inaccessible areas. In a re–run of the 2007 cholera outbreak in which 150 people died in Rayagada alone, 49 people have died in the district due to cholera and diarrhoea till now. (Source: The Indian Express)

  International News

(Dr Monica and Brahm Vasudev)

Elderly may benefit from arthroscopic surgery to repair rotator cuff tears

A study published in the October issue of the journal Arthroscopy has shown good results after arthroscopic surgery of rotator cuff tears in people above 70 years of age. Range of motion improved significantly. About 96% patients had significant decrease in their pain. Almost all the patients reported improved function in their shoulder, and 94% said they were satisfied and would undergo the surgery again if they had to make the decision over.

Metformin may help prevent tobacco-induced lung cancer

Metformin, the commonly used antidiabetic drug may reduce risk of cancer. However, there is insufficient evidence to recommend routine use of the drug for cancer prevention. But the evidence is strong enough that physicians and patients considering drug therapy for type 2 diabetes might want to lean toward metformin because of its ancillary effects (National Cancer Institute).

Patients may overestimate the benefit of heart stents

A survey has found that more than 80 % of patients were of the view that undergoing angioplasty and receiving a stent would reduce their chances of having a heart attack or dying from a heart attack. However, according to more than 80 % of surveyed cardiologists, angioplasties and stents only alleviate chest pain in these patients. The study is published in the Annals of Internal Medicine.

New treatment for bacterial infections may come from cockroach, locust brains

According to a new research from the University of Nottingham, tissues from cockroach and locust brains and nervous systems killed off 90% of E.coli and MRSA bacteria without harming the human cells they were attacking.

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

Diversify the diet to improve quality and micronutrient intake

  • Feed vitamin A–rich fruits and vegetables daily.
  • Feed meat, poultry, or fish daily or as often as possible, if feasible and acceptable.
  • Use fortified foods, such as iodized salt, vitamin A–enriched sugar, iron–enriched flour or other staples, when available.
  • Give vitamin–mineral supplements when animal products and/ or fortified foods are not available.
  • Avoid giving drinks with low nutrient value, such as tea, coffee and sugary beverages.


  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/ UNICEF, 1998.
  2. Dewey KG. Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/ WHO, 2003.
  3. WHO. Complementary Feeding: Family Foods for Breastfed Children. Geneva: World Health Organization, 2000.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

A couple has been trying to conceive for past 15 years. The lady is 38 years old and her menstrual cycles are now irregular and scanty. How can we help them?

A. At the age of 38 with irregular and scanty cycles, reduced ovarian reserve would be the first differential diagnosis. Basic infertility tests like semen analysis should have been done and ensured to be normal. A girl is born to release a fixed number of eggs by the time she reaches menopause which is about, 50 years of age, there are no viable eggs. About 15 years prior to menopause, the lady goes into a transition stage where her ovarian capacity falls drastically. The capacity of women to get pregnant is highest when she is less than 30 years of age. After 35 years, the fall in infertility is exponential. Certain tests like ultrasound, antral follicle count and blood tests like Follicle–stimulating Hormone and anti–Mullerian hormone will help in the diagnosis. High dose gonadotropin treatment may help this woman. Otherwise ovum donation is a viable option.

  ENT Update

Dr. Aru Handa MS, DNB (Dept Co–ordinator and Senior Consultant Deptt. of ENT Moolchand Medcity)

Prevention of ear pain while flying

It is better to take preventive measures at the slightest indication of ear blockage rather than wait till the ear pain becomes unbearable.

  • Maintain hydration. Keep taking sips of warm water.
  • Chew the candies given by air– hostess just before the descent or when you start feeling the pressure difference. Repeated swallowing, yawning, chewing, opening and closing the jaw and exercising the jaw helps.
  • If suffering from cold and sinus problem, take appropriate medication/s.
  • Topical and oral decongestants help in opening the eustachian tube blockage.
  • Valsalva’s maneuver (blowing of air through nose with both nose and mouth closed) helps in relieving the ear blockage, which occurs due to the development of relative negative middle ear pressure, at the time of descent. Same maneuver may worsen the blockage and pain, if performed after take off because then the ear blockage is due to relative positive middle ear pressure.
  • Consult ENT doctor if none of this works.
  Diabetes Update: Question of the day

Q: How do you enhance the adherence of patient to diabetes treatment regimen?

Diabetes is a chronic illness, and self–management plays a central role in the care of diabetes. Self–management is a complex task that involved each aspect of daily life, which cannot be managed by a single provider. A multiple approach to improve all aspects of patient adherence to treatment recommendations for diabetes has been studied. Success requires an alliance with patients and healthcare team, which includes a diabetologist, nurses, dieticians, diabetic educators, pharmacist and other specialized healthcare professionals. To improve adherence system, there are three categories of intervention:

Educational intervention: Teaching by nurse/paramedical and psychologist supplemented with audiotapes.

Behavioral intervention

  • Frequent follow–up by nurse at worksite clinic until treatment goals achieved.
  • Feedback through patient records (of medications) and blood pressure response.
  • Combination of medication chart and pill organizer.
  • Mailed prescription refill reminder and special packaging.
  • Nurse counseling plus reminder chart, structured counseling by pharmacist.
  • At end of hospitalization, phasing in patient responsibility for medication administration.
  • Telephone reminders and monitoring using computerized telephone system.
  • Educational videotape or picture book.

Affective intervention: Home visit to increase family support, group sessions to increase patient confidence and skills.

  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is a poison?

The WHO describes a poison as any substance that causes harm if it gets into the body. Harm can be mild, e.g. headache or nausea or severe e.g. fits or very high fever. Individuals who suffer severe poisoning may die. The amount of a chemical substance that gets into the body at one time is called the dose. A dose that causes poisoning is a poisonous dose or toxic dose. The smallest amount that causes harm is the threshold dose. If the amount of a chemical substance that gets into the body is less than the threshold dose, the chemical will not cause poisoning and may even have beneficial effects. For example, medicines have good effects if people take the right doses, but some can be poisonous if people take too much. In India, a National Poisons Control Programme is in place to improve the treatment and prevention of poisoning.

  Medi Finance Update

Q. To what extent can a doctor deposit an amount to PPF?

 A. Upto Rs. 70,000 in a financial year.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Haloperidol with any anti–cholinergic agent including Propantheline bromide.

Jan 1,2002

GSR 170(E)

  Lab Update

Prostate specific antigen (PSA)

Bacterial prostatitis may increase PSA levels, but they generally return to baseline 6 to 8 weeks after symptoms resolve.
Asymptomatic prostatic inflammation can also elevate PSA levels, but this diagnosis is made on biopsy and so cannot generally be used to defer screening tests.

  IJCP Special

Dr Good Dr Bad

Situation: A patient came with severe secondary MR with refractory end–stage heart failure.
Dr. Bad: Go for mitral valve repair
Dr Good: Try biventricular pacing.
Lesson: 2005 ACC/AHA heart failure guidelines: effectiveness of mitral valve repair or replacement for severe secondary mitral regurgitation (MR) in refractory end-stage HF is not established. (Circulation 2009;119:e391)

Make Sure

Situation: A patient with dengue fever developed shock
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

Quote of the Day

A wise man is one who is wise enough to feel sorry and say sorry when he commit an act that hurts others
(Contributed by Dr. GM Singh)

SMS of the Day

School life is like Reliance = Kar lo duniya muthi mey
College life is like Airtel = Aisi azadi aur kanha
Married life is like Idea = Jo badalde aapki duniya
(Contributed by Dr Chandresh Jardosh)

Hypertension Alert

Hypertensive urgency

If there are signs or symptoms of acute end-organ damage, the condition is considered a hypertensive emergency and is treated more aggressively.


Read this…………………

On a hot summer afternoon, an 81 year old widow is brought to the emergency room having been found down on the floor of her apartment. She was last seen 24 hours ago by her neighbors. She is confused and unable to give any history. She weighs 60 kgs on a bed scale. Vitals: afebrile, heart rate 100/minute, BP 120/80 mm Hg and oxygen saturation 95% on room air. Clinically patient is volume depleted. Cardiovascular, respiratory and GI exam are normal. She has no focal neurological deficit. Complete blood count is normal. Na: 160 (normal 136–145), K: 4.5 (normal 4–5), Cl: 117 (normal 95–105), HCO3: 20 (normal 22–28), glucose: 84 (normal 70–110), BUN: 80 (normal < 20), Creatinine 2 (normal < 1) and creatinine kinase is 400 (normal < 200). Urine analysis has markedly elevated WBCs and is positive for nitrites and leucocyte esterase. Chest X-ray and head CT were normal.

Which of the following fluids will best address her fluid and electrolyte abnormalities?

A. Dextrose 5%
B. Dextrose 5% with 0.45% normal saline (half–normal saline)
C. 0.9% sodium chloride
D. Isotonic sodium bicarbonate

(Contributed by Dr Ashish Verma MD)

The answer for yesterday’s Mind Teaser:"you are out of control"

Correct answers received from: Dr. K. Raju, Dr. Susheela Gupta, Dr Kalpana Mohan, Dr Jayashree B Keshav, In Charge - Scientific Publications, The Himalaya Drug Company, Dr Virender Prakash Gautam, Dr. Srikanth, National Manager – Scientific Services, Pharmaceutical Division, The Himalaya Drug Company, Dr Chandresh Jardosh, Dr Rajiv Khosla, Dr Anurag Jain, Dr Simran Singh, Dr.G.Padmanabhan, Dr AK Saxena, Dr Shashi Saini, Dr Nidhi Rawal, Dr Lokesh Garg,Dr. Sukla Das, Dr. P. C. Das, Dr. Naorem Sharat, Dr Ajmeer Singh, Dr Anupam Sethi Malhotra,  Dr Meera Rekhari, Dr Vishal, Dr Rashmi Chibber, Dr Nagendra Gupta

Answer for 14th September Mind Teaser is: “The letter "e," which is the most common letter in the English language, does not appear once in the long paragraph.

Correct answers received from: Dr Aditya Rattan, Dr Vijay Kansal, Dr. Dinesh Kumar S, Dr.G.Padmanabhan
Send your answer to ijcp12@gmail.com

  Humor Section

A man gifted his wife a diamond necklace for their anniversary and his wife did not speak to him for 3 months!!!
Why?? Was the necklace fake?
No, that was the deal… 
(Contributed by Dr Chandresh Jardosh)

Funny but true fact !!
Smile: A curve that can set a lot of things straight.
(Dr Chandresh Jardosh)

  An Inspirational Story

Something to Think About!
Imagine that you had won the following prize in a contest: Each morning your bank would deposit $86,400.00 in your private account for your use. However, this prize has rules, just as any game has certain rules.

The 1st set of rules:

  • Everything that you didn’t spend during each day would be taken away from you.
  • You may not simply transfer money into some other account. You may only spend it.
  • Each morning upon awakening, the bank opens your account with another $86,400.00 for that day.

The 2nd set of rules:
The bank can end the game without warning; at any time it can say, it’s over, the game is over! It can close the account and you will not receive a new one.

What would you personally do?
You would buy anything and everything you wanted right? Not only for yourself, but for all people you love, right?
Even for people you don't know, because you couldn’t possibly spend it all on yourself, right? You would try to spend every cent, and use it all, right?
Each of us is in possession of such a magical bank. We just can’t seem to see it.
Each morning we awaken to receive 86,400 seconds as a gift of life, and when we go to sleep at night, any remaining time is NOT credited to us.
What we haven't lived up that day is forever lost. Yesterday is forever gone.
Each morning the account is refilled, but the bank can dissolve your account at any time…WITHOUT WARNING. SO, what will YOU do with your 86,400 seconds today?
Those seconds are worth so much more than the same amount in dollars. Think about that, and always think of this:
Enjoy every second of your life, because time races by so much quicker than you think. So take care of yourself, be Happy, Love Deeply and enjoy life!
(Contributed by Dr Chandresh Jardosh)

  Readers Responses
  1. Dear Sir, I am one of the of silent admirer of ur work.u r a true genius nd ur work in the field of medicine has helped lacks of peoples, I have been reading u r bulletion regularly and go thru all the contents, they r really good and I take an opportunity to suggest all medicos as well as non medicos to go thru it regularly. Thanks. Dr Prachi
  Public Forum

(Press Release for use by the newspapers)

Prevention Strategy Relies on Lifestyle

Stenting may not always be the answer to treating heart disease with stable angina said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event-free survival than those who had undergone percutaneous coronary intervention (PCI).

In the study 70% of patients in the exercise program had event-free survival -- no stroke, heart attack, or death -- compared with 50% of stented patients after four years.

Exercise is ostensibly an important part of any type of prevention, and that it should be instituted for "anyone with stable coronary heart disease."

The study on stenting versus exercise come was a continuation of a pilot study first reported in 2004 in  the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients.

The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home.

Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 minutes of moderate-intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.

  Conference Calendar

Dr. Sood Nasal Research Foundation Announces

Rhinology Update
November 11–15, 2010
22nd National Endoscopic Sinus Surgery Course
November 11–12, 2010
Venue: Dr. Shroff’s Eye & ENT Hospital, New Delhi.

For information contact:
Dr. V. P. Sood
Course Chairman
Ear, Nose & Throat Center
212, Aditya Arcade, 30, Community Center,
Preet Vihar, Vikas Marg, Delhi–110092 (India).
Tel: 011–22440011, 42420429.
E–Mail: drvpsood@gmail.com,`vpsood@drsoodnasalfoundation.com
Web site: www.drsoodnasalfoundation.com

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday–BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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