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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


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  Editorial …

18th November 2011, Friday

Statins may worsen asthma

Statins might worsen asthma control, researchers said here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting.

Statin influence allergic inflammation with immunomodulatory activities, said lead author Safa Nsouli, MD, director of the Danville Asthma and Allergy Clinic in California. These include the downregulation of the T helper (TH)1 phenotype response and the upregulation of the TH2 phenotype response. At 3 months, patients in the statin group had a 20% decrease in FEV1 from baseline, compared with patients in the nonstatin group, who had a 10% decrease. At 6 months, the decreases were 28% and 12%, respectively; at 12 months, the decreases were 35% and 14%.

The use of beta–agonist rescue inhalers was also higher in the statin group. At 3 months, peak expiratory flow was decreased by 18% in the statin group, and by 4% in nonstatin group. At 6 months, it was decreased by 25% and 9%, respectively, and at 12 months, it was decreased by 39% and 11%.

Statin users had more nighttime wakening and a greater increase in daytime symptoms than nonusers. At 12 months, the increase in nighttime wakening was 31% and 3%, respectively, and the increase in daytime asthma symptoms was 35% and 3%.

Patients with asthma who need to take statins should not stop taking these drugs. But it does mean that they should be treated more aggressively.

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

Statins may worsen asthma

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011–Cancer Checkup Camp

18th MTNL perfect Health Mela in association with International oncology organised a Free Heart and Cancer Checkup Camp at Ansal Plaza on 17th October 2011.

Dr K K Aggarwal
    National News

Ghaziabad emerges world’s second fastest growing city

Indian cities overwhelmingly dominate a new list of the world’s fastest–growing 100 cities in terms of urbanisation, with three leapfrogging to the top 10 and 22 others figuring prominently in a crop of boomtowns usually reserved for those in China. Ghaziabad occupies the second, Surat fourth and Faridabad eighth slots in the list presented by City Mayors, a global think–tank that studies urban affairs to promote good governance. The City Mayors’ catalogue of the fastest–growing cities and urban areas between 2006 and 2020 is based on past growth and forecasts by international and national statistics organisations. (Source: TOI, Nov 17, 2011)

For comments and archives

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

FDA Panel votes to expand use of pneumococcal vaccine to adults

An FDA advisory committee has voted 14–1 in favor of expanding the indication for the pneumococcal 13–valent conjugate vaccine (Prevnar 13) to include use in adults 50 and older. Currently the Pfizer vaccine is approved only for use in children. (Source: Medpage Today)

For comments and archives

Systolic BP that’s too low after stroke not good either

Systolic blood pressure that is too low –– as well as too high –– may put patients who have had a noncardioembolic ischemic stroke at risk for another one, researchers found. (Source: Medpage Today)

For comments and archives

World’s 7 billionth citizen more likely to die of diabetes

Washington: Scientists have revealed that world citizen number 7 billion is less likely to die from infectious diseases like measles or even AIDS, and more likely to contract diabetes or other non–communicable diseases (NCDs), as they are now the leading causes of deaths globally. The pathological picture changes, as more than half the world's 7 billion people live in urban areas. "Our new world citizen number 7 billion is more likely to grow up in an urban setting, which increases his or her risk of getting diabetes, as well as chronic obstructive pulmonary disease (COPD), cancer and heart disease," said Siri Tellier, from the Copenhagen School of Global Health at the University of Copenhagen. (Source: http://zeenews.india.com/news/health/health–news/world–s–7-billionth–citizen–more–
likely–to–die–of–diabetes_14584.html, Nov 15, 2011)

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   Twitter of the Day

@DrKKAggarwal: Watch Padma Shri Awardee Dr KK Aggarwal on All kids need cholesterol tests as… http://www.youtube.com/watch?v=wcZTO3vIkoo&feature=share via @youtube

@DeepakChopra: This means more to me than all the professional reviews of Leelahttp://youtu.be/_caAUXF–vNY

    Spiritual Update

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

Only a doctor can be a Jain and a Christian at the same time

I recently participated in a seminar on Christian–Jain collaboration organized by World Fellowships of Religions, The pontifical Council for Inter–Religious Dialogue, the Catholic Bishop’s conference of India and Delhi Catholic Archdiocese.

For comments and archives

   An Inspirational Story

(Ms Ritu Sinha)

Shake It Off and Step Up

A parable is told of a farmer who owned an old mule. The mule fell into the farmer’s well. The farmer heard the mule ‘braying’ – or whatever mules do when they fall into wells. After carefully assessing the situation, the farmer felt sorry for the mule, but decided that neither the mule nor the well was worth saving. Instead, he called his neighbors together and told them what had happened and asked them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially, the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back, a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back: he should shake it off and step up! This is what the old mule did, blow after blow.

"Shake it off and step up… shake it off and step up… shake it off and step up!" he repeated to encourage himself. No matter how painful the blows, or distressing the situation seemed, the old mule fought "panic" and just kept right on shaking it off and stepping up!

You guessed it! It wasn’t long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him, actually end up blessing him. All because of the manner in which he handled his adversity.

In addition to "shaking it off and step up," we Christians have our heavenly Father to help get us through rough times. When the going gets rough, keep looking up, and trust him.

For comments and archives

   Cardiology eMedinewS

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

CSI News

Cardiac stem cell update

For comments and archives

The Balloon Jerk Sign a new predictor of Severe MR after Percutaneous Transluminal Mitral Commissurotomy

For comments and archives

AHA update:AIDA STEMI: No benefit of IC over IV abciximab

For comments and archives

AHA update: Whom not to bridge: Dental, cataract, and colonoscopy patients

For comments and archives

Facts and figures in cardiology

The Global Burden of Diseases study reported estimated mortality from CAD in India at 1.6 million in the year 2000. (Indian Heart J 2005;57:632–8). Extrapolation of this estimate shows the current burden of CAD in India to be more than 32 million patients.

    Fitness Update

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

Simple 5–step guide to form your habit

Tell Everyone

Research has shown that accountability is vital for building a habit, so tell everyone! Tell friends and loved ones about what you are doing, keep a log of your workouts, post your workouts on a forum, but most importantly let it be known what you are doing. Make sure you log and post your workouts daily or every two days. One great way to stay accountable is to get a training partner to keep you going. Accountability is a key part of the habit forming process so do not miss out on this part.

After you have completed your month of workouts or daily activity you will have formed a basic exercise habit. Now you can spend the second month expanding on the intensity. Start to hone your workouts a little, set yourself some goals and reward yourself when you complete them. You can set goals based on time, weights lifted, distance covered etc.

Keep going, stay consistent and NEVER give up, it will get easier and you never know you might start to enjoy it!!!

For comments and archives

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Drink none for the road. The limit is 80 mg per 100 ml of blood, or 35 g in 100 ml of breath.

    Medicine Update

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

GERD: Clinical Presentation

The diagnosis of GERD is often made clinically based on the bothersome symptoms or signs that may be associated with GER symptom descriptions are unreliable in infants and children younger than 8 to 12 years of age, and many of the purported symptoms of GERD in infants and children are nonspecific. There is a continuum between GER and GERD with no cutoff separation between the physiological reflux (GER) and pathological reflux (GERD). A third type of GER exists which is secondary to pyloric stenosis, neurological impairment, nasogastric tubes and food allergy.

For comments and archives

  Legal Question of the Day

(Dr M C Gupta)

I am a faculty member in the forensic medicine department of a hospital. An unconscious woman was admitted in the emergency with injuries on her body. Police was informed. We did not prepare an MLR (Medicolegal report) because consent is needed for the same and the injured person could not give consent because she was unconscious. We gave a copy of the hospital case sheet containing details about the details of the injuries to the police. The police want information/opinion about the nature of injury and kind of weapon used. I believe such information/opinion cannot be given in the absence of MLR which could not have been prepared due to non–availability of consent. What are your comments?

  • Consent is not a requirement for preparing an MLR in a police case. Here, a police case means a person case that is brought or is deemed to have been brought by the police. A person with injury who comes on his own or is brought by others and in respect of whom the police has been informed would be deemed to have been brought by the police.
  • Even if it is accepted for sake of argument that consent is necessary and the injured is not fit to give consent, it is well known that consent can be given on his behalf by the next of kin or relatives or friends and even by a team/board of doctors acting in the best interest of the patient when nobody else is available to give consent.
  • It is the duty of every citizen, much more so of a medical officer/FMT specialist to help the police in investigation of crime. It is a breach of such duty when information that is available/expected to be available is not given to the police even when the police asks for it.
  • In my opinion, the proper course would have been as follows:
    • After informing the police, a proper MLR should have been prepared.
    • When the police comes, the original of the MLR should have been given to the police and the copy should have been retained in the hospital records.
    • If there is even a remote possibility of the case turning out to be a medicolegal/police case in future, then, even though a written statement might be available that the injured person or his relatives do not want an MLR, the medical officer, while not preparing a formal MLR, should write down detailed notes almost on the same lines as an MLR and such records should be carefully maintained for possible future use if needed in legal proceedings later.
  1. My immediate comments are that this episode further confirms my following convictions:
    • That contrary to what the forensic medicine faculty believes, they are not legal/medicolegal experts by virtue of having a degree in FMT. They are often ignorant about basic principles of law, as evident in this case.
    • That the FMT course syllabus and teaching and training need to have a much stronger component of law than at present.
    • That a degree in law ought to be made at least a desirable, if not essential qualification for appointment as an FMT specialist.
  2. My considered comments about this case are as follows:

For comments and archives

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Porphyrin Tests: Indications

When a patient has symptoms that suggest an acute neurologic/psychiatric porphyria, such as abdominal pain, tingling in hands or feet, and/or confusion or hallucinations, or a cutaneous porphyria, such as reddening, blistering, or scarring on sun-exposed skin.

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emedinews revisiting 2011
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    IJCP Special

Dr Good Dr Bad

Situation: A 32–year–old man with sustained fever of 102°F for 2 weeks in whom the diagnosis is not apparent after 3 days of diagnostic studies is admitted in the hospital.
Dr Bad: Manage him as a case of PUO.
Dr Good: Investigate further. Don’t diagnose PUO yet.
Lesson: Pyrexia of unknown origin (PUO) is said to occur in patients with sustained fever of 101° F or more for 3 weeks in whom the diagnosis is not apparent after one week of diagnostic studies.

For comments and archives

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Every new beginning comes from some other beginning's end. Seneca

    Mind Teaser

Read this…………………

Which is not true regarding hemangioendothelioma of liver?

a) It is a rare tumor.
b) It is highly vascular.
c) It involves both lobes of the liver.
d) It has extrahepatic spread in 50% cases.

Yesterday’s Mind Teaser: All are precancerous for carcinoma colon except:

a. Crohn’s disease
b. Bile acids
c. Fats
d. Carotene

Answer for yesterday’s Mind Teaser: d. Carotene

Correct answers received from: Gita Arora, Dr Ragavan Moudgalya, Dr BB Aggarwal, Dr Sukla Das, Thakor Hitendrasinh G, Dr PC Das, Dr HL Kapoor, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Ravi, Raju Kuppusamy, Dr Jainendra Upadhyay, Anil Bairaria, Dr Neelam Nath.

Answer for 16th November Mind Teaser: d) Hyperglycemia
Correct answers received from: Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Ravi, Raju Kuppusamy, Dr Jainendra Upadhyay, Anil Bairaria, Dr Pawan Gupta, Dr Neelam Nath.

Send your answer to ijcp12@gmail.com

    Laugh a While


Doctor, Doctor! Have you got something for a bad headache?
Doc: Of course. Just take this hammer and smash yourself in the head. Then you’ll have a bad headache.

    Medicolegal Update

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

Gratuitously advices shall not be considered liable when the actions are within the established medical procedures

  • Any doctor who is qualified by medical council and renders emergency care or treatment to a person suffering or appearing to suffer from cardiac arrest, which may include the use of an automated external defibrillator, in good faith and without compensation, shall be immune from civil liability for any personal injury as a result of care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary prudent person would have acted under the same or similar circumstances, except damages that may result for the gross negligence of the person rendering emergency care. This immunity shall extend to the licensed physician.
  • If a doctor passes the scene of an accident in which some person has been injured and is in need of urgent medical attention he would not be held to have been negligent if he does not render assistance, as no doctor/patient relationship has been established and in consequences the doctor owes the patient no legal duty.
  • If, however, the doctor goes to the assistance of a person who is injured in an accident, a doctor /patient relationship is at once established. When any physician gratuitously advises medical personnel at the scene of an emergency episode by direct voice contact, to render medical assistance based upon information received by voice or biotelemetry equipment, the actions ordered taken by the physician to sustain life or reduce disability shall not be considered liable when the actions are within the established medical procedures.
  • A Doctor has a duty to exercise reasonable skill and care regardless of whether or not his services are being given gratuitously. A national health policy is required to be formulated to render emergency treatment to a person.
  • If such a practitioner fails to attend an emergency call and a complaint is made against him it may well be that some disciplinary action will be taken against him by the health authority/medical council

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

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

The triad of early diagnosis, timely treatment and mass awareness

The triad of early diagnosis, proper treatment and mass awareness in cancer is essential said Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India.

Unless there are good centres in a city which can provide complete treatment if the cancer is detected in time then only the awareness will have an impact. If the general feeling is that, what is the use of diagnosis, if there is no cure’ then the programme is going to be a failure.

In awareness, more important is to detect cancer at its early stage. Cancers of head, neck, lung and cervix are preventable. If treated in time a large number of cancers are curable. Most of the childhood tumors are curable, so are a few of the adult cancers like Hodgkin’s disease, non Hodgkin’s lymphomas and breast cancer.

The incidence of cancer is increasing in the West but the mortality is decreasing.

It is unfortunate to note that while in the U.S.A. most of the breast cancers are detected in stage 0 or 1, the same are detected in our country at stage 3 or 4.

Nobody should die of cervical cancer. In the West the mortality has come down to zero. But in India it is still one of the major causes of cancer deaths. The only answer seems to be detection of early cancer by periodic PAP smear test but not more than 2% of Indian women get their annual PAP smears done.

Everybody after the age of 40 must be screened for the presence of early cancer but if a family history of cancer (e.g. breast, other organs) is present, the screening must start at the age 25.

There are a few cancers (e.g. blood cancers) which cannot be predicted or detected by annual screening. The emphasis for them has to be on the right and timely treatment.

Most of the stomach cancers in India are misdiagnosed as acidity for atleast 6 months to one year, and this loss of time is many a time responsible for progression of cancer to an incurable stage.

This is the time to create awareness amongst public and to refresh knowledge of doctors. One should remember that first treatment is the best treatment. Never leave the first chance. If at the first instance the diagnosis is missed, or only partial treatment is started, the outcome can never be successful.

All cancers are not identical. They all behave differently and the response to therapy may also be different. Mythical beliefs should be removed only then a uniform level of public awareness can be expected.

For comments and archives

    Readers Responses
  1. Dear Sir, I never miss reading. Because highly informative emedinews. Regards: Dr KB Pant
    Forthcoming Events

CSI 2011

63rd Annual Conference of the Cardiological Society of India

Date: December 8–11, 2011.
Venue: NCPA Complex, Nariman Point, Mumbai 400021

Organizing Committee

B. K. Goyal – Patron
Samuel Mathew – President CSI
Ashok Seth – President Elect & Chairman Scientific Committee
Lekha Adik Pathak – Chairperson
Satish Vaidya & C. V. Vanjani – Vice Chairman
N. O. Bansal – Organizing Secretary
B. R. Bansode – Treasurer
Ajit Desai , Ajay Mahajan , G. P. Ratnaparkhi – Jt. Org. Secretaries
Shantanu Deshpande , Sushil Kumbhat , Haresh Mehta – Asst. Org. Secretaries
D. B. Pahlajani, A. B. Mehta , M. J. Gandhi , G. S. Sainani, Sushil Munsi, GB Parulkar, KR Shetty – Advisory Committee

Contact: Dr. Lekha Adik Pathak, Chairperson, CSI 2011; Dr. Narender O. Bansal, Org. Secretary, CSI 2011 Tel: 91 – 22 – 2649 0261/2649 4946, Fax: 91 – 22 – 2640 5920/2649 4946.
Email: csi2011@ymail.com, csimumbai2011@gmail.com Website: www.csi2011mumbai.com

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews “Doctor of the Year Award “ function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta