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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

  Editorial …

21st February, 2011, Monday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

FDA issues warning on asthma drug in preterm labor

Injectable terbutaline should not be used to prevent preterm labor or to treat it beyond 48 to 72 hours because of a potential for cardiac problems or death. FDA is requiring that a boxed warning and contraindication be added to the terbutaline label for both the injectable and tablet form of the drug. The warning applies to use both in the hospital and outpatient setting. Terbutaline is sometimes used off–label for treating preterm labor and uterine hyperstimulation. Terbutaline also has been used off–label over longer periods of time in an attempt to prevent recurrent preterm labor. The agency said the label change was based on its review of postmarketing reports of maternal death and serious cardiovascular adverse events submitted to the Adverse Event Reporting System (AERS) associated with obstetric use of terbutaline.

An AERS search identified 16 maternal deaths that were reported from the initial marketing of the drug, in 1976, until 2009. In addition, the FDA said it has identified 12 maternal cases of serious cardiovascular events associated with use of terbutaline that were reported between Jan. 1, 1998 and July 2009. These events included cardiac arrhythmias, myocardial infarction, pulmonary edema, hypertension, and tachycardia.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  2nd eMedinewS revisiting 2010

Dr VK Monga talks on
‘Chikungunya Epidemic in Delhi’

Audio PostCard
  Quote of the Day

(Dr GM Singh)

Music and rhythm find their way into the secret places of the soul. Plato

    Photo Feature (from the HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010

Padma Shri and Dr B Roy National Awardee Dr KK Aggarwal with Dr. Naresh Trehan, Chairman and Managing Director, Medanta - The Medicity in the 2nd eMedinewS revisiting 2010 on 9th January 2011 at Maulana Azad Medical College.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Cashless facility for patients

Moolchand is proud to have been selected by India's leading insurance companies (National Insurance Company Ltd., United India Insurance Company Ltd., The New India Assurance Company Ltd. and The Oriental Insurance Company Ltd.) to extend cashless facility for patients.

PMO strikes balance for medical education regulator

NEW DELHI: Prime Minister’s Office has fine tuned the solution of right regulator for medical education. It has been decided that while health ministry’s National Council for Human Resource in Health (NCHRH) will be the sole regulator for medical education — including all degress like MBBS and MD — the human resource development ministry’s National Commission for Higher Education & Research (NCHER) will have a say on medical as well as inter–disciplinary research. NCHRH will be the sole custodian of MBBS courses throughout the country, including syllabus, quality and number of seats in each institute. (Source: The Times of India, Feb 16, 2011)

    International News

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

Eating spinach makes for more efficient muscles

After taking a small dose of inorganic nitrate for three days, healthy people consume less oxygen while riding an exercise bike. A new study in the February issue of Cell Metabolism traces that improved performance to increased efficiency of the mitochondria that power our cells. The researchers aren’t recommending anyone begin taking inorganic nitrate supplements based on the new findings. Rather, they say that the results may offer one explanation for the well–known health benefits of fruits and vegetables, and leafy green vegetables in particular.

"We’re talking about an amount of nitrate equivalent to what is found in two or three red beets or a plate of spinach," said Eddie Weitzberg of the Karolinska Institutet in Sweden. "We know that diets rich in fruits and vegetables can help prevent cardiovascular disease and diabetes but the active nutrients haven’t been clear. This shows inorganic nitrate as a candidate to explain those benefits."

The new study offers yet another benefit of nitrate and the nitric oxides that stem from them. It appears that the increased mitochondrial efficiency is owed to lower levels of proteins that normally make the cellular powerhouses leaky. "Mitochondria normally aren't fully efficient," Weitzberg explained. "No machine is." "Among the more consistent findings from nutritional research are the beneficial effects of a high intake of fruit and vegetables in protection against major disorders such as cardiovascular disease and diabetes," the researchers concluded.

(Dr Monica and Brahm Vasudev)

Combined bevacizumab, chemotherapy treatment linked to higher mortality risk

Cancer patients treated with a combination of the angiogenesis inhibitor Avastin (bevacizumab) and chemotherapy are 50 % more likely to die from their treatment rather than their disease, according to a study published in the Journal of the American Medical Association.

Maternal stroke history associated with MI risk in women

A family history of stroke, especially among female relatives, may help predict the risk of acute coronary syndromes in women, according to a study published online in Circulation: Cardiovascular Genetics.

Mortality from pulmonary embolism appears to be low for patients treated in ED

Mortality from pulmonary embolism is surprisingly low for patients treated in the emergency department, according to a study published in the Feb. 8 issue of the Journal of the American College of Cardiology.

Analysis suggests breast cancer testing accuracy improves with repeat MRIs

MRI scans to detect breast cancer yield fewer false-positive results over time, according to a study in Radiology.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is endometriosis?

In endometriosis, the endometrium (tissue from the lining of the uterus) forms and grows in places outside the uterus. These growths may cause pain and infertility. Up to 50% of women who have endometriosis may experience infertility. These lost endometrial cells respond to the body’s hormones in a similar manner as they would inside the uterus. Normally, the endometrium within the uterus thickens to prepare for an embryo. When pregnancy does not occur, the extra lining breaks down and is shed during menstruation.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

How can one diagnose primary hypothyroidism in setting of acute illness?

Hypothyroidism is a strong possibility if TSH is >25–30. (will be above 20 only 3% of the time in NTI)

  • Subnormal free T4 in the absence of treatment with agents that suppress TSH (dopamine, corticosteroids, phenytoin, carbamazepine) is strongly suggestive of hypothyroidism.
  • Presence of goiter and anti–thyroid antibodies (peroxidase, thyroglobulin) favor primary hypothyroidism.
  • Elevated rT3 in the setting of TSH >10 renders diagnosis of hypothyroidism unlikely.

For queries contact: drneelam@yahoo.com

    Medicolegal Update

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

What are the ideal containers for viscera preservation?

Each container must be carefully labeled and preferably countersigned by the autopsy surgeon. Some jurisdictions will require actual seals on the containers themselves or the package into which they are placed for transport, or both. Accompanying signed ‘exhibit labels’ with serial numbers corresponding exactly with numbers on the jars may be required. The containers must be given by the doctors to the investigating office. The police officer must hand over the samples personally to a member of the laboratory staff and a record of this chain of evidence must be kept, so that there can be no criticisms leveled at any one when the matter comes to court, raising doubts about the correct identity of the samples.

  • Glass bottles of one liter capacity is used for viscera preservation
  • Clean, wide mouthed fitted with glass stoppers should be used for each viscera.
  • Rubber inserts should not be used under caps because it can extract from the contents, certain poisons such as chloroform and phenols.
  • Glass containers should be washed with sulphuric acid chromate solution, rinsed with distilled water and dried.
  • Polyethylene bags or containers can be used, but volatile poison may diffuse through plastic.
  • When lungs or other tissues are to be preserved for analysis of volatile substances nylon bags should be used, as they are not permeable to such substances.
  • Blood should be collected in screw–capped bottle of about 30ml or in plastic capped tubes of 10ml.
    Legal Question of the Day

(Contributed by Dr Akash Deep)

Doc in the dock over medico–legal report
(Saurabh Malik, Tribune News Service)

Chandigarh, February 15: Dr Karan Singh, medical officer with the community health centre in Mahendragarh, is in the dock. Condemning the medical officer for his failure to prepare a medico–legal report while admitting a patient, the Punjab and Haryana High Court has asked the Director of health services, Haryana, to initiate disciplinary proceedings against him.

The Division Bench of Justice Satish Kumar Mittal and M Jeyapaul has also made it clear that the medico–legal report "should also mention the person, who actually brought the injured to the hospital for treatment". The Bench asserted that: "We are constrained to note the unbecoming conduct of Dr Karan Singh… Except for the cryptic reply, no material is available on record to explain as to why Dr Karan Singh failed in his duty to prepare the medico–legal report qua Suman.

"In a medico–legal case, the doctor on duty, who admits the patient, shall prepare the medico–legal report… The doctors serving in the government hospitals are bound to assist the investigating agency and the court for the purpose of advancing justice. "Failure to prepare the medico–legal report, relating to the injured person admitted to the hospital for treatment, would sometimes pave way for great injustice. Dismissing Rajesh’s appeal, the Bench added: "An embarrassing situation had been created by the inaction on the part of Dr Karan Singh. We are constrained to direct Director, health services, Haryana, to initiate disciplinary proceedings against him for dereliction of duty as medical officer."



    Useful Websites

(Dr Surendernikhil Gupta)


Infant and under-five mortality in Afghanistan


    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Increased: Primary hyperthyroidism, parathyroid hormone secreting tumors, vitamin D excess, metastatic bone tumors, chronic renal failure, milk–alkali syndrome, osteoporosis, thiazide drugs, pagets disease, multiple myeloma, sarcoidosis.

Decreased: Hypoparathyroidism, insufficient vitamin D, hypomagnesemia, renal tubular acidosis, hypoalbuminemia, chronic renal failure (phosphate retention), acute pancreatitis.

    Medi Finance Update

Stock Market

  • Law of Economics, when the bank interest rate reduces, then stock market has to rise and vice versa. When the interest rate reduces, the profit increases.
  • Even a genius in stock market will be wrong in 3 out of 10 innings.
  • Do not invest in stock market directly, take the mutual funds route.
Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Drug Update

List of approved drug from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Citicholine 500mg + Piracetam 400mg Tablets
For the treatment of acute stroke
    IMSA Update

International Medical Science Academy (IMSA) Update

Immunization Practices: ACIP recommendations

In 2010, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices expanded the recommendation for influenza vaccination to include all individuals 6 months of age and older.

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was found to have high ESR and elevated CRP.
Dr Bad: You are suffering from an inflammatory disease.
Dr Good: It may be a part of diabetes.
Lesson: In diabetes, both ESR and CRP can be high at the same time and this can be due to IL–6 secretion by adipose tissue.

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminium toxicity.
Reaction: Oh my God! You should have put him on Magaldrate preparations?
Lesson: Make sure to remember that Magaldrate preparations do not cause aluminium toxicity in patients undergoing dialysis.

Exercise tips

Bones lose calcium and weaken with age, but strength training can help slow or sometimes even reverse this trend. Not only can strength training make you look and feel better, but it can also result in better performance of everyday activities, such as climbing stairs and carrying bundles. Stronger muscles also mean better mobility and balance, and thus a lower risk of falling and injuring yourself. In addition, more lean body mass aids in weight control because each pound of muscle burns more calories than its equivalent in fat.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

The Emperor Moth and the Struggle

The emperor moth is the most majestic species among all the moths. It has wide wings spanning out majestically when it flies. Before it can become a full grown moth, it has to be a pupa in a cocoon. Now, the interesting fact about the moth’s cocoon is that the neck of the cocoon is very narrow. In order that it become a moth, the pupa of the moth must squeeze its way out of the narrow neck.

One day a man found a cocoon of an emperor moth. He took it home so that he could watch the moth come out of the cocoon. He sat and watched the moth struggling to force the body through that little hole. Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no farther. It just seemed to be stuck. Then the man being kind decided to help the moth. So he took a pair of scissors and snipped off the remaining bit of the cocoon. The moth then emerged easily. But it had a swollen body and small, shriveled wings. He expected that the wings would enlarge and expand to be able to support the body which would contract in time. Neither happened! In fact, the little moth spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly. A few days later, it died.

What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the moth to get through the tiny opening was the way of forcing fluid from the body of the moth into its wings so that it would be ready for flight. Once it achieved its freedom from the cocoon. Freedom and flight would only come after the struggle. By depriving the moth of a struggle, he deprived the emperor moth of health.

You see, the struggles of life, heartaches and pains are necessary if you want to be great. Instead of cursing them, understand them while you are experiencing them. They are part of the making of a man.


Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: _it
Answer for yesterday’s Mind Teaser: blanket

Correct answers received from: Dr Rakesh Bhasin, Dr.Riyazul Qamar Khan, Dr. H.L. Kapoor,Dr Sudipto Samaddar, Dr KP Rajalakshmi.

Answer for 19th February Mind Teaser: Eggs over easy
Correct answers received from: Dr Sudipto Samaddar, Dr Neelam Nath

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr GM Singh)

Old Computer Terms

BUG: What your eyes do after you stare at the big mean computer screen for more than 15 minutes. Also: what computer magazine companies do to you after they get your name on their mailing list.

CHIPS: The fattening, non–nutritional food computer users eat to avoid having to leave their keyboards for meals.


Knowledge is amusing

What do bullet proof vests, fire escapes, windshield wipers and laser printers all have in common?

Ans: All invented by women.

    Readers Responses
  1. Dear Sir, emedinews is really the best medical newspaper. Regards: Dr Anupam
    Public Forum

(Press Release for use by the newspapers)

Children need to be screened for the heart before participating in sports

Sudden cardiac death amongst athletes is a rare but devastating event. Most victims are usually young and, apparently, healthy but many have underlying undiagnosed heart disease. This was stated by President, Heart Care Foundation of India Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee.

As per American Heart Association Guidelines, children and adolescents who are to undergo athletic training need medical clearance. Majority of sudden deaths amongst athletes are due to malignant irregularities in the heart rhythm such as ventricular tachycardia and ventricular fibrillation. The precipitating factors can be prolonged physical training or unaccustomed athletic activities.

In athletes under the age of 35, the most common cause of death is underlying congenital heart disease and for those above the age of 35, it is the presence of blockages of the coronary arteries.

As per American Heart Association, in every school/college, the attached doctor should evaluate all students with a 12–step history and examination to rule out high risk cases that need further evaluation. European Society of Cardiology also recommends an additional standard 12–lead ECG before a medical clearance is given for both competitive as well as recreational athletic activities. For those master athletes who are above the age of 35, they will need an additional exercise testing before they can be given a clearance for athletic activity.

A Diagnostic Echocardiography is indicated with clinical, historical and physical findings suggest possibility of structural heart diseases. Athletes on pacemaker should not engage in sports as bodily collision may damage the pacemaker system.

The 12–element AHA recommendations for pre participation cardiovascular screening of competitive athletes

  1. Exertional chest pain/discomfort
  2. Unexplained syncope/near–syncope
  3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
  4. Prior recognition of a heart murmur
  5. Elevated systemic blood pressure
  6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in one relative
  7. Disability from heart disease in a close relative <50 years of age
  8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long–QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
  9. Heart murmur
  10. Femoral pulses examination to exclude aortic coarctation
  11. Physical features of Marfan syndrome
  12. Brachial artery blood pressure (sitting position, both arms)
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

National workshop-cum-seminar on role of yoga in prevention and management of diabetes mellitus

The Advanced Centre for Yoga Therapy, Education & Research (ACYTER) and Department of Physiology JIPMER in collaboration with Morarji Desai National Institute of Yoga, (MDNIY) New Delhi.
Date: March 1 & 2, 2011
Venue: JIPMER. For more details please contact:acyter.jipmer@gmail.com
Mobile: 9994628679 (Dr Zeena Sanjay), 9488820627 (Sri Eayasettiaseelon), 9842311433 (Dr Ananda Balayogi Bhavanani)

6th Annual Conference of Indian Academy of Nephrology (IANCON-2011)

Date: 12th -13th March 2011,
Venue: Taj Deccan, Banjara Hills, Hyderabad-34
Faculty: Dr MS Amarsen, Dr KV Jhony, Dr SC Dash, Dr Kashivishweswaran Dr V Sakhuja, Dr RK Sharma Dr Girishnarayan, Dr Anuradha, Dr SK Agarwal, Dr P Sundarajan, Dr P Keshivya, Dr Ravi Raju, Dr Dilip Pahari, Dr LC Sharma, Dr Sanjeev Saxena, Dr Sanjay Gupta, Dr Abhijit Tarapdhar, Dr PP Verma, Dr Harun Rashid, Dr Sampath Kumar, Dr Sanjib Sharma, Dr S Padmanabhan.
Topics: CKD Symposium (From India, Nepal, Bangladesh), Newer concepts in the pathogenesis of hypertension, Fluid and Electrolyte & AKI, RAAS in treatment of Diabetic Nephropathy, Primary Prevention of CKD: Trials & tribulation in Indian condition, Vitamin-D andchronic kidney disease, Mycophenolate Vs Cyclyophosphamide in Lupus nephritis, Individual zinganemia therapy, How to monitor Immunosuppression minimization, Obesity Diabetes epidemic, Life Style changes & therapeutics, BKV and CMV Nephropathy, Leptospiraand Acute Kidney Injury, HIV Nephropathy, Hypophosphatemia and Renal Disease, Immunosuppressantand risk of Malignancy, Pregnancy ARF, Expanding Dialysis services in Andhra Pradesh,Making kidney transplant easier for less privileged, Cardiovascular risk reduction in CKD Organizing Secretary: Dr. Sree Bhushan Raju, Associate Professor, Dept of Nephrology, NIMS, Hyderabad
Contact- Mob: 09848492951, sreebhushan@hotmail.com
Website: www.ian2011.in
Note: “Prof SC Dash oration in Nephrology” from this year onwards.
Three awards each in oral, poster and imaging in Nephrology sessions

Registration for Delegates Amount
Up to 15th February 2011
Rs. 1500/-
Up to 5th March 2011
Rs. 2000/-
Spot registration
Rs. 2500/-
Rs. 500/-

DD/Cheque in favor of “IANCON- 2011” payable at Hyderabad.Add Rs 100 for outstation cheque.

ICC Cricket World Cup 2011

World Cup Schedule… very very creative


World Fellowships of Religions and Perfect Health Parade

First ever Conference which will talk about science behind all Religions, Dharmas and Pathies under one roof
Subject: Global Warming, Ethnic Crises, How to be Healthy
Date: Sunday 3rd April, 2011
Venue: Maulana Azad Medical College, New Delhi
Time: 8 AM – 4 PM
Register: rekhapapola@gmail.com

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