Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of 1st Mega Ajmer Health Camp 2012

  Editorial …

20th April 2012, Friday

FDA Puts 16 Drugs on Watch List

The US Food and Drug Administration has issued its latest quarterly list of drugs to monitor after having identified potential signs of serious risks or new safety information in the agency’s Adverse Event Reporting System (AERS) database during the last 3 months of 2011.

Potential Signals of Serious Risks/New Safety Information Identified by AERS, July to September 2011

Product Name: Active Ingredient (Trade) or Product Class

Potential Signal of a Serious Risk/New Safety Information

Additional Information (as of February 15, 2012)*



Optic neuritis

The Warnings and Precautions section of the labeling for adalimumab and golimumab was updated December 2011 to include optic neuritis.

Clevidipine butyrate intravenous emulsion

Hypoxemia (decreased oxygen saturation)

The Adverse Reactions section of the labeling for clevidipine butyrate intravenous emulsion was updated December 2011 to include decreased oxygen saturation.

Dabigatran etexilate mesylate

Bleeding events, including hemorrhage with fatal outcome

The Dosage and Administration section of the labeling for dabigatran was updated January 2012 to include information about monitoring renal function in patients taking dabigatran and adjusting dose if necessary because dabigatran’s anticoagulant activity and half–life are increased in patients with renal impairment.

FDA is continuing to evaluate this issue to determine the need for any further regulatory action.

Diazepam injection (Valium)

Propylene glycol toxicity




The Adverse Reactions section of the labeling for infliximab was updated October 2011 to include sarcoidosis.

Topical analgesic nonprescription monograph products containing menthol, methyl salicylate, and capsaicin

Application site burns

FDA is continuing to evaluate this issue to determine whether the current labeling for the monograph products is adequate.


Kidney stones

FDA is continuing to evaluate this issue to determine whether the current labeling for orlistat, which includes kidney stones, is adequate to address other kidney–related adverse events.

The Warnings and Precautions and Adverse Reactions sections of the labeling for Xenica (the prescription orlistat product) were updated January 2012 to include increases in urinary oxalate.

The European Medicines Agency is also evaluating orlistatfor this potential risk.

Valproate products: valproic acid, divalproex sodium, valproate sodium

Liver failure and injury (involving hereditary mitochondrial disorders, such as Alpers–Huttenlocher syndrome and other conditions)


Potential Signals of Serious Risks/New Safety Information Identified by AERS, October to December 2011

Product Name: Active Ingredient (Trade) or Product Class

Potential Signal of a Serious Risk/New Safety Information

Additional Information
(as of February 15, 2012)*


Death from intrathecal administration (medication error)

The Dosage and Administration and Contraindications sections of the labeling for bortezomib were updated January 2012 to include fatal events with intrathecal administration.

Brentuximab vedotin

Progressive multifocal leukoencephalopathy (PML)

The Boxed Warning and Warnings and Precautions sections of the labeling for brentuximab were updated January 2012 to include PML.

Fluoroquinolone products

Peripheral sensorimotor neuropathy

FDA is continuing to evaluate this issue to determine whether the current labeling, which contains information about peripheral sensorimotor neuropathy, is adequate.

Gabapentin HCl

Increase in blood creatine phosphokinase levels and rhabdomyolysis


Gadolinium–based contrast agents products

Acute kidney injury

FDA is continuing to evaluate this issue to determine whether the current labeling, which contains information about kidney injury, is adequate.

Iloprost inhalation solution



Loperamide HCl–containing products



Magnesium sulfate for injection

Fetal skeletal demineralization, hypermagnesemia, and other bone abnormalities with continuous long–term use in pregnant women


Milnacipran HCl

Homicidal ideation



Anaphylaxis and infusion reactions


Phenytoin and nondepolarizing neuromuscular blocking agents

Drug interactions resulting in decreased effectiveness of the nondepolarizing neuromuscular blocking agent


Polyethylene glycol 3350 over–the–counter oral laxative

Neuropsychiatric events

FDA decided that no action is necessary at this time on the basis of available information.

Proton–pump inhibitor over–the–counter (OTC) products

Clostridium difficile–associated diarrhea


Rubidium Rb82 generator

Unintended radiation exposure to strontium isotopes after myocardial imaging

Rubidium Rb82 generator was voluntarily recalled by the manufacturer in July 2011; a return to the US market is planned. The Boxed Warning, Dosage and Administration, and Warnings and Precautions sections of the labeling for rubidium Rb82 generator were updated February 2012 to include information about unintended radiation exposure.

Sorafenib tosylate

Osteonecrosis of the jaw



Serious skin reactions, including drug reaction with eosinophilia and systemic symptoms (DRESS) and Stevens–Johnson syndrome (SJS)


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

FDA Puts 16 Drugs on Watch List

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

Lecture – Eat less to live more

On world Health Day Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal interacts with students of Mount Abu Public School, Rohini

Dr K K Aggarwal
    National News

(Contributed by Dr. MS Ashraf, President, Tamil Nadu Medical Council)

NCHRH Bill will usurp powers of States, says Jayalalithaa

Chief Minister Jayalalithaa on Thursday voiced "vehement opposition" to National Commission for Human Resources for Health (NCHRH) Bill 2011, arguing that it sought to usurp the powers of States in the area of health human resources by creating new structures that hit the very root of federalism. In a letter to Prime Minister Manmohan Singh, she stated that the Bill, which has been referred by the Rajya Sabha to the Standing Committee on Health and Family Welfare, effectively puts the leadership and decision–making process with regard to medical, dental and paramedical education in the hands of about 25 persons, all to be nominated by the Centre. "This undermines the powers of the State governments, which are left with no role to play in policy issues related to health manpower planning, curriculum and course design as well as approval of new institutions offering courses in medicine and allied disciplines."

The need-based planning for medical, dental and paramedical manpower should follow regional and local demands. This would best be achieved only by giving adequate representation for the States in policy–making bodies. Status quo may be maintained with regard to the functioning of the existing National and State Councils, which, Ms. Jayalalithaa said, may be strengthened and improved with increased participation of the State governments at the level of the National Council. (Source: The Hindu, April 12, 2012)

For comments and archives

Health Bill poison pill, Jaya to PM

CHENNAI: Chief Minister J Jayalalithaa on Thursday vehemently opposed the National Commission for Human Resources for Health Bill, which has been referred by the Rajya Sabha to the Standing Committee on Health and Family Welfare. "The NCHRH Bill usurps the powers of the States in the critical area of health human resources by creating new structures which hit at the very root of federalism," the Chief Minister said in her letter to Prime Minister Manmohan Singh. She said the new Bill effectively puts the leadership and decision–making process with regard to medical, dental and paramedical education in the hands of about 25 persons—all Central government nominees. "This undermines the powers of the State governments, which are left with no role to play in policy issues related to health manpower planning, curriculum and course design as well as approval of new institutions offering courses in medicine and allied disciplines," the CM pointed out. (Source: Express News Service, April 13, 2012)

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

Psoriasis monotherapies differ little in effectiveness

A recent cross–sectional study comparing psoriasis monotherapies with methotrexate, adalimumab, etanercept, ustekinumab, and narrow–band ultraviolet–B (UV–B) found small differences in response that may not be clinically significant. Patient response was also lower in this clinical practice setting than had been reported in clinical trials with these same therapies. (Source: Medscape)

For comments and archives

Surgery wins again for obese diabetics

Yet another study has found that bariatric surgery is a better diabetes treatment in obese patients than medical therapy, Italian researchers said, confirming results from other recent trials. (Source: Medpage Today)

For comments and archives

Timing key in rewriting addict’s memory

Using a type of exposure therapy to wipe out the emotional triggers that drive drug addiction may be most effective when the brain is in the process of recalling and re–storing memories, Chinese researchers found. (Source: Medpage Today)

For comments and archives

Decision to test should be based on patient needs

Nearly half of MedPage Today readers who responded to our poll about the "Choose Wisely" campaign to curb overused medical procedures evinced a balanced response, saying the decision depends on the test. The poll sprung from a move by nine professional organizations that outlined five possibly overused tests and treatments, which could be reigned in as an overall effort to reduce unnecessary medical procedures. (Source: Medpage Today)

For comments and archives

Acetaminophen top choice for first treatment of RA pain

Rheumatologists associated with the 3e (evidence, expertise, exchange) Initiative report a set of 11 evidence–based recommendations for drug therapy to manage pain in inflammatory arthritis (IA; predominantly rheumatoid arthritis (RA)), as well as a new treatment algorithm for clinical use. The recommendations were published online March 24 in Rheumatology. (Source: Medscape)

For comments and archives

   Twitter of the Day

@DrKKAggarwal: A slight move is all that matters i…: http://youtu.be/COsCTSU8JUc via @youtube

@DeepakChopra: The one and only reality is infinite possibilities.

    Spiritual Update

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

Am I A Spiritual Seeker?

Every one cannot be a spiritual seeker. In fact majority are not interested in seeking spiritual knowledge and they keep themselves busy in the worldly desires. To become a good seeker one need to acquire many qualities.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What do you understand by normal reproductive anatomy?

The ovaries are two small glands, each about 1½ inches long and three–fourth of an inch wide, located in a woman’s pelvic cavity. They are attached to each side of the uterus (womb) by ligaments, near the fallopian tubes. About once a month, an egg matures in a follicle (a fluid–filled ovarian cyst containing the egg) after which it is released by one of the ovaries. The fimbriae (finger–like projections) of the fallopian tubes sweep over the ovary and move the egg into the tube. If sperm are present in the woman’s reproductive tract, the egg may be fertilized in the tube. The fertilized egg (now called an embryo) begins to divide. The embryo travels through the tube and into the uterus where it implants in the endometrium (uterine lining). The embryo’s journey through the tube takes 4 to 5 days.

For comments and archives

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

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

Q. Do any diseases debar a donor from giving blood?

A. Yes, if the donor has suffered from any of the under–mentioned diseases:

  • Fever: He should not have suffered from fever for the past 15 days.
  • Jaundice: A donor must not have his blood–tested positive for Australia antigen.
  • Blood–transmitted diseases such as syphilis, malaria, filaria etc., debar a donor from donating blood till he is treated and is free of the disease.
  • Drug: If a donor is taking drugs like aspirin, anti–hypertensives, anti–diabetics, hormones, corticosteroids etc., he is unfit to donate blood.
  • AIDS. No person who is HIV–positive can be allowed to donate blood.

For comments and archives

   An Inspirational Story

(Ms Ritu Sinha)

The mouse trap

A mouse looked through the crack in the wall to see the farmer and his wife open a package. "What food might this contain?" the mouse wondered. He was devastated to discover it was a mousetrap.

Retreating to the farmyard, the mouse proclaimed the warning: "There is a mousetrap in the house! There is a mousetrap in the house!"

The chicken clucked and scratched, raised her head and said "Mr. Mouse, I can tell this is a grave concern to you, but it is of no consequence to me. I cannot be bothered by it."

The mouse turned to the pig and told him "There is a mousetrap in the house! There is a mousetrap in the house!" The pig sympathized, but said "I am so very sorry, Mr. Mouse, but there is nothing I can do about it but pray. Be assured you are in my prayers."

The mouse turned to the cow and said "There is a mousetrap in the house! There is a mousetrap in the house!" The cow said "Wow, Mr. Mouse. I’m sorry for you, but it’s no skin off my nose."

So, the mouse returned to the house, head down and dejected, to face the farmer’s mousetrap alone.

That very night a sound was heard throughout the house – like the sound of a mousetrap catching its prey. The farmer’s wife rushed to see what was caught. In the darkness, she did not see it was a venomous snake whose tail the trap had caught. The snake bit the farmer’s wife. The farmer rushed her to the hospital and she returned home with a fever.

Everyone knows you treat a fever with fresh chicken soup, so the farmer took his hatchet to the farmyard for the soup’s main ingredient. But his wife’s sickness continued, so friends and neighbors came to sit with her around the clock. To feed them, the farmer butchered the pig. The farmer’s wife did not get well; she died. So many people came for her funeral; the farmer had the cow slaughtered to provide enough meat for all of them.

The mouse looked upon it all from his crack in the wall with great sadness.

So, the next time you hear someone is facing a problem and think it doesn’t concern you, remember: when one of us is threatened, we are all at risk. We are all involved in this journey called life. We must keep an eye out for one another and make an extra effort to encourage one another. Each of us is a vital thread in another person’s tapestry.

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, www.mymonavie.com/sonraj)

Vitamin B12 as an Energizer: Reputation Exceeding Evidence

In the past few years, B vitamins have gained a reputation as "energizers" and appear in a multitude of energy drinks and shots and as supplements in pill form. Specifically, many Americans associated vitamin B12 shots with improved energy. However, according to many doctors, this reputation exceeds the limits of evidence. Most research indicates that B12 supplementation is mainly effective in reducing fatigue in people who are deficient in the vitamin. According to NHANES about 3.2% of people over 50 are deficient in B12. Risk factors for deficiency include age over 50 years, taking a PPI or H2 blocker (medications to reduce gastric reflux), taking metformin (a diabetes medication), following a strict vegetarian diet, or having inflammatory bowel disease. People with one or more of these risk factors should ask their doctor about testing B12 levels. Some factors that may improve energy levels in most people, who have normal B12 levels, include regular physical activity, eating a healthy diet, drinking enough water, and getting adequate sleep.

For comments and archives

   Cardiology eMedinewS

Women suffer more ICD complications Read More

Mediterranean diet good for small brain vessels Read More

Air pollution spikes bump up MI risk Read More

Intravascular ultrasound improves TLR outcomes of bifurcation lesions PCI Read More

   Pediatric eMedinewS

Parasite duo to blame in infant toxoplasmosis Read More

Kids have little protection from new flu virus Read More

Vitamin D not tied to school performance Read More

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    IJCP Special

Dr Good Dr Bad

Situation: An obese patient with metabolic syndrome wanted a prescription for liposuction.
Dr Bad: Go ahead.
Dr Good: It won’t be beneficial.
Lesson: Liposuction can reduce weight and fat but does not improve insulin sensitivity.

For comments and archives

Make Sure

Situation: A patient with acute heart attack died on the way to the hospital.
Reaction: Oh my God! Why was the patient not accompanied by the doctor?
Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression CPR can be given, if the heart stops, on the way.

For comments and archives

    Legal Question of the day

(Prof. M C Gupta Advocate & Medico–legal Consultant)

What is the legal status of foreign surgeons who come for camps and conferences and do surgery here? What will be their responsibility regarding complications/misconduct? Should they take prior permission from MCI or local authority.


  1. Nobody can treat a patient in India unless he is registered with the medical council here. The foreign surgeons need to take a special short time/temporary registration with the MCI. Operating without such permission would be illegal.
  2. Foreigners should not venture illegally in their own interest. If they operate and a police complaint/FIR is registered against them for criminal negligence, they may find it difficult to leave the country and may even be arrested.
  3. Hospitals sponsoring such surgery will be fully liable in law for compensation and also for criminal negligence for allowing an unlicenced person to operate and causing harm.
  4. It is also possible, depending upon legal provisions, that a complaint alleging negligence may be made or referred to the foreign medical council where the surgeon is registered and the council may decide upon the complaint and take action against him.
  5. If a hospital thinks that getting a patient operated by the foreign surgeon but not showing his name as the person conducting the surgery in the medical records will save the hospital or the surgeon from the requirements or consequences mentioned above, this is a fallacy. It would be deemed as fraudulent on the part of the hospital.

For comments and archives

    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity)

Prevention of HAIs amongst healthcare providers

It is extremely important that we, the healthcare providers continue to practice and do the work we have chosen to do and at the same time come to no harm ourselves. How can we do that? We can take precautions and practice basic hygienic commonsense practices, which will help us not to get infections from our patients and at the same time not give infection to our patients.

Some of the highly transmissible diseases are vaccine preventable. As detailed in CDC (vide MMWR Dec 26 (RR–18) 1997:46;1–46 and MMWR Dec 1 (RR–15)2006: 55;1–48) General Recommendations on Immunizations, all HCWs must be immunized against vaccine-preventable diseases as per the National Immunization Schedule of the Country, in our case EPI. We must make sure that we have taken all the vaccines as per EPI, India.

Briefly these include HBV, MMR, BCG (TB), Varicella, Influenza, DPT, Polio and Enteric fever. Vaccines for diseases like HAV, Meningococcal, Pneumococcal disease outbreaks and so many emerging infections like H1N1, etc. should be taken under defined special circumstances e. g. outbreak of a disease which may adversely affect us. Sometimes we may need to take Hyper Immune Gamma globulins (readymade antibody to get instant protection) as e. g. in an unprotected HCW getting needle stick injury with HBV–positive blood.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Keep your face always toward the sunshine – and shadows will fall behind you. Walt Whitman

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Iron deficiency anemia

In men and postmenopausal women, anemia is usually caused by gastrointestinal blood loss from certain types of cancer (esophagus, stomach, colon), long–term use of aspirin or nonsteroidal anti–inflammatory drugs (NSAIDs), peptic ulcer disease.

Tests to diagnose iron deficiency anemia (IDA) include:

  • Serum iron: This test measures the amount of iron in your blood.
  • Serum ferritin: It is a protein that helps store iron in your body.
  • Transferrin level
  • Total iron–binding capacity (TIBC)
  • Reticulocyte count
  • Serum transferrin receptor
    Mind Teaser

Read this…………………

What lifestyle changes may reduce a woman’s risk of breast cancer?

A. Staying trim as an adult.
B. Drinking a glass of red wine each day.
C. Getting moderate to vigorous physical exercise regularly.
D. A and C.
E. There is little you can do to lower your chances of developing breast cancer

Yesterday’s Mind Teaser: How often should you have a Pap smear?

A. Once a year after puberty.
B. Once a year after either turning 21 or having sexual intercourse for the first time.
C. Once a year after age 21 and every two years after 30.
D. Once a year if you’re not in a monogamous relationship.
E. Once a year unless you’ve been vaccinated against the human papillomavirus (HPV). Then the screening is not necessary.

Answer for yesterday’s Mind Teaser: C. Getting moderate to vigorous physical exercise regularly.

Correct answers received from: Dr Valluri Ramarao., Yogindra Vasavada, Dr U Gaur, Dr R K Sahoo, Dr.Chandresh Jardosh, Muthumperumal Thirumalpillai, Raju Kuppusamy, Dr Jainendra Upadhyay

Answer for 18th April Mind Teaser: A. Diabetes
Correct answers received from: BB Gupta, Dr Ratnesh Kanwar

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Law of Cat Composition

A cat is composed of Matter + Anti–Matter + It Doesn’t Matter.

    Medicolegal Update

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

What is the first aid for poisonous bites and stings?

People often panic if they have been bitten or stung. You should tell the patient that many snakes, spiders, insects and sea creatures are harmless and that even the bites and stings of dangerous animals often do not cause poisoning.

Keep the patient calm and still. Moving the bitten or stung limb speeds up the spread of venom to the rest of the body. Fear and excitement also make the patient worse. The patient should be told not to use the limb and to keep it still and below the level of the heart. The limb may swell after a while, so take off the patient’s rings, watch, bracelets, anklets and shoes as soon as possible. A splint and a sling may help to keep the limb still.

Avoid doing the following:

  • Do not cut into the wound or cut it out.
  • Do not suck venom out of the wound.
  • Do not use a tourniquet or tight bandage.
  • Do not put chemicals or medicines on the wound or inject them into the wound (for e.g., potassium permanganate crystals).
  • Do not put ice packs on the wound.
  • Do not use proprietary snake bite kits.
  • The patient should lie on one side in the recovery position so that the airway is clear, in case or vomiting or fainting.
  • Do not give the patient anything by mouth – no food, alcohol, medicines or drinks. However, if it is likely to be a long time before the patient gets medical care, give the patient water to drink to stop dehydration.
  • Try to identify the animal, but do not try to catch it or keep it if this will put you, the patient or others at risk. If the animal is dead take it to hospital with the patient, but handle it very carefully, because even dead animals can sometimes inject venom.
  • As soon as possible, take the patient to a hospital, medical dispensary, or clinic where medical care can be given. The patient should not walk but should keep as still as possible. If there is no ambulance or car, carry the patient on a stretcher or trestle, or on the crossbar of a bicycle.
  • Antivenom should only be given in a hospital or medical Centre where resuscitation can be given, because the patient may have an allergic reaction. If available, antivenom should be used if there is evidence of severe poisoning. It should not be used when there are no signs of poisoning.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Remember the health windows

The window for the deadliest form of heart attack, called ST–elevation myocardial infarction (STEMI), ideally is within 30 minutes for clot–dissolving drug treatment, and within 90 minutes for angioplasty. Window means the period before which the specific treatment should start, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India. Thirty percent of STEMI patients do not get clot–busting drugs. Twenty percent are not candidates for clot-busting drugs and, of these, 70 percent do not get angioplasty.

The window period for a paralysis patient to receive clot–dissolving drug is also 3 hours. The earlier definition of transient ischemic attack (or mini paralysis) "focal neurologic symptoms of ischemic cause that last less than 24 hours" has now changed to "a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than 1 hour, and without evidence of acute infarction." The paradigm shift is so that more and more number of cases can get clot–dissolving drugs.

For a victim of road traffic accident, the window to shift the patient is 10 minutes, called ‘Platinum Ten minutes’ and the victim to get basic resuscitation done is one hour called ‘Golden Hour’.

    Readers Response
  1. Dear Sir, I enjoy reading emedinews. Pls continue. Regards: Dr TS Khanna
    Forthcoming Events
Dr K K Aggarwal

Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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