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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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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 …

21st April 2012, Saturday

Excerpts of talk by Dr. Anupam Jaggi, Clinical Hematologist, Sir Ganga Ram Hospital (IMSA update)

  • Whenever doing surgery under spinal or epidural anesthesia, always get bleeding profile done as any bleeding in these areas can be detrimental. The safest anesthesia in such a situation is General Anesthesia or Local Anesthesia. Bleeding time, clotting time and PEG tests are of no use.
  • Safe surgery is possible when the total leukocyte count is more than one thousand.
  • Safe surgery is possible when the platelet count is more than 1 lakh. Laparoscopic surgery is safe if the platelet count is more than 30 thousand.
  • When the patient is on warfarin and he needs a surgery, one should stop warfarin 72 hours before surgery and start enoxaparin (LMW heparin) 1ml/kg. The last dose of LMW heparin should be given 12 hours before surgery. After surgery LMW heparin should be restarted 24 hours later.
  • If the PT–INR is raised and surgery is contemplated, one should give 1mg Vitamin K intravenous. Wait for six hours and repeat INR. PT should normalize by this time and the patient can be operated after that.
  • If the patient has arterial thrombosis, do the following tests: Lupus anticoagulant (or lupus antibody), homocysteine, A1c and abdominal fat.
  • If there is an active bleeding due to bleeding disorder, one should give 15 ml/kg of FFP in 45 minutes altogether. Wait for 6 hours and repeat INR.
  • In acute venous thrombosis, factor C, factor S and factor 5 Leyden are reduced for three weeks and therefore testing at this moment is not reliable.
  • If a patient has spontaneous DVT, he should be on lifelong oral anticoagulants.
  • If a patient has normal PT and abnormal APTT, do a mixing test. Take patient plasma with equal amount normal plasma and repeat APTT. If it is normal, there is a factor deficiency (8, 9, 11, 12, and 13). Factor 12 deficiency does not cause bleeding; it increases thrombosis not bleeding. Patient can undergo surgery safely. If the APTT is still abnormal, it indicates presence of inhibitor or antibody. In such cases, test for lupus anticoagulant.
  • Buff count can prepared in a lab by using two units of blood.
  • Granulocyte colony stimulating factor can be given for 15–20 days. GCSF, if given for 7–10 days, can increase TLC to up to 30000. This is done for harvesting stem cells.
  • Patient with negative bleeding history does not require routine coagulant screening prior to surgery. Bleeding history means details of previous surgery and trauma, family history, details of any anti–clotting medicine.
  • If the bleeding history is positive or there is a clear clinical indication, tests are required.
  • The first–line tests are APTT and PT.

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

Earth Day Celebration at DPS School, Mathura Road

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day organized at DPS Mathura Road

World Earth Day was celebrated by Heart Care Foundation of India jointly with Delhi Public School.
A walk was organized to mark the World Earth Day. Over 500 school children participated in the walk

Dr K K Aggarwal
    National News

More incentives for ASHAs

NEW DELHI: The accredited social health activists (ASHAs) — the first port of call for health care under the National Rural Health Mission (NRHM) — will be entrusted with additional responsibilities, albeit with better monetary incentives, as the Mission Steering Group – the highest decision making body of the NRHM — has approved the proposal for involving them in activities such as spacing between births, promoting iodised salt and village sanitation.

The ASHAs will now have a major role to play in counselling newly–married couples and those with one child to have their first child after two years of marriage and space their children for at least three years. For this, the ASHAs would be paid an incentive of Rs. 500 per couple she manages to convince for spacing between births. And, as part of the communitisation strategy of the NRHM, it has been decided to involve ASHAs in organising the monthly village health sanitation and nutrition committee (VHSNC) meeting for which she will be paid an incentive of Rs. 150 a month. This meeting will be followed by the meeting of women and adolescent girls where the health and sanitation needs of adolescent girls would be discussed. There are 5 lakh VHSNCs but frequency and performance of these meetings and involving ASHAs could help in streamlining this. Importantly, it has also been decided to further incentivise ASHAs by providing an additional Rs. 100 for every child who receives complete first year immunisation and Rs. 50 for every child who further completes two years of immunisation as per the stipulated schedule. As of now, ASHA gets Rs. 150 for mobilising children to immunisation session sites. (Source: The Hindu, April 17, 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

IMRT best option for prostate cancer

For prostate cancer patients, intensity–modulated radiation therapy (IMRT) may offer better disease control than standard radiation therapy, but proton therapy won’t provide additional benefits, researchers found. (Source: Medpage Today)

For comments and archives

Infectious scleritis often tied to herpes virus

Almost 75% of cases of infectious scleritis result from herpes virus, but the diagnosis is often missed, a new paper warns. (Source: Medscape)

For comments and archives

Once–daily doxycycline effective against chlamydia

A new higher–dose formulation of once–a–day doxycycline worked as well as the standard twice–daily capsules in men and women with uncomplicated urogenital Chlamydia infection in a phase III trial. The new daily 200-mg tablet could improve adherence, said lead investigator Dr. William Geisler of the University of Alabama at Birmingham and colleagues in a paper online in Clinical Infectious Diseases. (Source: Medscape)

For comments and archives

Experts urge continued study of dyslexia

Research on dyslexia has enhanced scientific understanding and has improved medical treatments for this neurodevelopmental disorder over the past few years, but many questions remain, which, when answered, will improve the lives of children who struggle to learn to read, according to a Seminar published online April 17 in the Lancet. (Source: Medscape)

For comments and archives

Igaki–Tamai stent safe out to 10 years

Long–term data of 50 patients treated with the Igaki–Tamai stent, the first fully bioabsorbable stent implanted in the coronary arteries, shows the stent to be safe out to 10 years and associated with major adverse cardiovascular event (MACE) rates similar to those of bare–metal stents. (Source: Medscape)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Remember the health windows in English: http://youtu.be/bkx8XJlZh_8 via @youtube

@DeepakChopra: Most people do not realize that the challenges they experience in their life are there for a spiritual reason.

    Spiritual Update

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

Brahma Satyam Jagat Mithya

That the soul exists is the main message of Upanishads. According to Sri Sankaracharya, one can sum up the entire message of Vedanta in three crisp aphorisms. ‘Brahma Satyam, Jagat Mithya and Jivo Brahmaiva naparah’.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is ovulation?

Ovulation, the release of an egg from its follicle in one of a woman’s two ovaries. Once ovulated, the egg is picked up by one of the fallopian tubes and begins traveling toward the uterus.

For comments and archives

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

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

Q. Is the blood tested before transfusion?

A. Yes. Every donor’s and every patient’s blood is screened for AIDS, VDRL, jaundice (HBsAg, HCV), malaria etc. with most modern techniques before any blood is issued from our blood bank.

Transfusion Reactions

  1. Febrile (Fever) or pyrogenic reactions within 1 to 24 hours
  2. Allergic reactions
  3. Hemolytic reaction–this is severe and some times fatal (death)
  4. Transmission of diseases–syphilis, jaundice, malaria, AIDS etc.
  5. Cardiac overload
  6. Electrolytic reactions e.g. too much citrate causes calcium depletion, which results in tetany, bleeding etc., excess potassium causes hyperkalemia.
  7. Hemorrhagic reactions due to massive transfusion.
  8. Transfusion siderosis (Iron excess)
  9. Thrombophlebitis
  10. Iso–sensitization.
  11. Air and fat embolism (rare)

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The Three Races

A fable retells the story of the young athletic boy hungry for success, for whom winning was everything and success was measured by such a result.

One day, the boy was preparing himself for a running competition in his small native village, himself and two other young boys to compete. A large crowd had congregated to witness the sporting spectacle and a wise old man, upon hearing of the little boy, had travelled far to bear witness also.

The race commenced, looking like a level heat at the finishing line, but sure enough the boy dug deep and called on his determination, strength and power… he took the winning line and was first. The crowd was ecstatic and cheered and waved at the boy. The wise man remained still and calm, expressing no sentiment. The little boy however felt proud and important.

A second race was called, and two new young, fit, challengers came forward, to run with the little boy. The race was started and sure enough the little boy came through and finished first once again. The crowd was ecstatic again and cheered and waved at the boy. The wise man remained still and calm, again expressing no sentiment. The little boy, however, felt proud and important.

"Another race, another race!" pleaded the little boy. The wise old man stepped forward and presented the little boy with two new challengers, an elderly frail lady and a blind man. "What is this?" quizzed the little boy. "This is no race" he exclaimed. "Race!" said the wise man. The race was started and the boy was the only finisher, the other two challengers left standing at the starting line. The little boy was ecstatic; he raised his arms in delight. The crowd, however, was silent showing no sentiment toward the little boy.

"What has happened? Why not do the people join in my success?" he asked the wise old man. "Race again", replied the wise man, "…this time, finish together, all three of you, finish together" continued the wise man. The little boy thought a little, stood in the middle of the blind man and the frail old lady, and then took the two challengers by the hand. The race began and the little boy walked slowly, ever so slowly, to the finishing line and crossed it. The crowd was ecstatic and cheered and waved at the boy. The wise man smiled, gently nodding his head. The little boy felt proud and important.

"Old man, I understand not! Who are the crowds cheering for? Which one of us three?" asked the little boy. The wise old man looked into the little boy’s eyes, placing his hands on the boy’s shoulders, and replied softly… "Little boy, for this race you have won much more than in any race you have ever ran before, and for this race the crowd cheer not for any winner!"

    Fitness Update

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

Higher energy density diet linked to higher body weight

As obesity rates continue to rise, researchers have looked into single nutrients and diet patterns to find out what is causing the problem and can be done to change it. In the past, fat and carbohydrates have both been identified as possible culprits. A recent article published in the Journal of the Academy of Nutrition and Dietetics reviewed 17 studies on energy density and weight from multiple countries. Energy density is the amount of calories in a given portion of food. The study found that decreasing the energy density of the overall diet produced the most successful weight loss outcomes. And in most studies reviewed, those who ate less energy dense diets were able to consistently maintain weight loss over time.

Given this information, it is recommended that people consume more foods low in energy density. These are foods with lower energy content per portion size, and include lean meat, fruits, vegetables, and whole grains. It is also important to eat moderate amounts of foods containing good fats like almonds and avocados while avoiding the energy dense foods lower in nutrients like fast foods or processed foods containing saturated fats and added sugars.

For comments and archives

  Cardiology eMedinewS

Pre Hypertension Linked to AF Read More

New Anti Platelet Before Cardiac Surgery Read More

Grief Raises Heart Attack Risk Read More

  Pediatric eMedinewS

High Marks For Automated Screens In Pediatric Waiting Room Read More

Adolescents Benefit From Attending 12–Step Meetings Read More

Physical Comfort Takes Sting Out Of Infant Shots Read More

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    IJCP Special

Dr Good Dr Bad

Situation: A patient of recurrent miscarriage wanted to know her future risk of heart attack.
Dr. Bad: There is no risk.
Dr. Good: There is a future risk of heart attack.
Lesson: Women who suffer recurrent miscarriage have an increased risk of heart attack. Each miscarriage increases heart attack risk by 40% and having > 2 miscarriages increases the risk by more than four–folds. In women who had > 3 miscarriages, the risk is increased 9–folds. One stillbirth increases the risk of heart attack by 3.5 times (Kharazmi E, et al. Pregnancy loss and risk of cardiovascular disease: a prospective population–based cohort study (EPIC–Heidelberg. Heart 2011 Jan;97(1):49–54).

For comments and archives

Make Sure

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that every time a patient is given penicillin injection, anti anaphylaxis measures are available.

For comments and archives

    Legal Question of the day

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

Q. How should I proceed with my problem described below:

"I have been HOD cardiovascular surgery in a well–known medical institute/college for 10 years and am currently the chief cardiovascular surgeon in a wellknown corporate hospital. I have an MS degree from India and a postgraduate 2year degree (called CLINICAL ORDINATOR in cardiovascular surgery) from Tashkent state medical institute. I applied to the MCI for recognition of my superspecialty course in USSR but the course has not been so recognised. I do not know where I stand legally after 26 years of active cardiac surgery practice as regards my status as a cardiac surgeon. I want a permanent solution".


  1. You have no problem and hence there is no need for any solution.
  2. If you can be an HOD/professor in an MCI recognised medical college for 10 years and the MCI does not register you in its records as a person having a super–specialist qualification, the problem lies with the MCI, not you.
  3. If you really want a permanent solution for the sake of others less fortunate and less well placed than yourself, this is what you should do. You should consult your lawyer, issue a notice to the MCI, and, thereafter, if the notice is not complied, file a writ petition in the HC against the MCI.

For comments and archives

  Quote of the Day

(Dr GM Singh)

HATRED weakens the liver;
GRIEF weakens the lungs;
WORRYING weakens the stomach;
STRESS weakens both the heart and the brain; and
FEAR fails the kidneys…so

    How I Treat

(Dr. Anupama Jaggia, Chairperson and Hony. Consultant, Dept. of Clinical Hematology, Sir Ganga Ram Hospital, New Delhi )

Vitamin B12 deficiency

  • Always use IM vitamin B12, never rely upon Iv or oral formulations
  • Continue injections for at least 6 to 8 weeks
  • Start with vitamin B12 alone and later add folic acid
  • Wait patiently for response (It can take upto 1 month to improve Hb by even 1gm/dl).
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Antidiuretic hormone

  • To help detect, diagnose and determine the cause of antidiuretic hormone (ADH) deficiency or excess
  • To investigate low blood sodium levels (hyponatremia)
  • To distinguish between the two types of diabetes insipidus
    Mind Teaser

Read this…………………

What is the number one cancer killer of women?

A. Colon cancer
B. Breast cancer
C. Lung cancer
D. Cervical cancer
E. Esophageal cancer

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: D. A and C.

Correct answers received from: Dr PC Das, Dr BB Aggarwal, Dr Jainendra Upadhyay.

Answer for 19th April Mind Teaser: C. Getting moderate to vigorous physical exercise regularly.
Correct answers received from: Dr JC Mitra.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Funny Definitions

Intaxication: Euphoria at getting a tax refund, which lasts until you realize it was your money to start with Hipatitis: Terminal coolness.

Dopeler effect: The tendency of stupid ideas to seem smarter when they come at you rapidly.

    Medicolegal Update

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

What is ethanol and isopropanol poisoning?

The effect of a dose of ethanol depends on how much alcohol a person regularly drinks

The effect of a dose of ethanol depends on how much alcohol a person regularly drinks. Someone who does not usually drink much alcohol may be badly affected by an amount that would otherwise have very little effect on a person who regularly drinks large amounts. Children may suffer severe poisoning after drinking just a mouthful of aftershave, mouthwash or perfume. Isopropanol is more poisonous than ethanol. Serious poisoning can be caused by using isopropanol as rubbing alcohol, if large amounts are rubbed on the skin and absorbed into the body. Both ethanol and isopropanol slow down the brain, causing unconsciousness and shallow breathing. Isopropanol vapor is irritant to eyes, nose and throat and poisonous, if inhaled. Regularly drinking large amounts of ethanol causes chronic poisoning, resulting in many changes in the body, particularly in the brain, the liver, and the heart.

Signs and symptoms of acute poisoning

  • The patient’s clothes and breath may smell of alcohol; patients who have swallowed isopropanol smell of acetone
  • Slurred speech – difficulty in performing simple tasks, staggering walk, – nausea, vomiting, and abdominal pain which are more severe after swallowing isopropanol – drowsiness– blurred or double vision– unconsciousness – fits

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Mercury is hazardous to health

World Earth Day organized at DPS Mathura Road

Talking to a gathering of over one thousand children, Padma Shri & Dr. B.C. Roy National Awardee, Dr. K K Aggarwal, President, Heart Care Foundation of India, said that one should not use mercury–based thermometer and blood pressure instruments. They can be risky to life. Two thermometers are broken each year for every bed in a hospital. For 40,000 beds in Delhi alone, 80,000 thermometers get broken every year and the mercury of these thermometers enters the environment. Each thermometer contains ½ g of mercury meaning 4 kg of mercury is released in the environment every year only from breaking of thermometers in various hospitals in the city of Delhi.

Mercury is toxic and with active and chronic exposure, affects brain and kidney. Acute exposure can cause nausea, blurred vision, painful breathing and excessive salivation. Chronic exposure can lead to high blood pressure, memory disturbance, vision disturbance, tremors and personality changes. Mercury can cross the blood brain barrier and affect the brain development in the child in the pregnant or lactating women.

Flagging the World Earth Day Walk organized by Heart Care Foundation of India jointly with Delhi Public School, Mathura Road, Rear Admiral M M Chopra, Chairman DPS Mathura Road and Vice Chairman DPS Society, said that every school child should plant a tree to reduce the problem of global warming in the society.

Chief Guest, Military Secretary to the President of India– Lt. Gen. A.K. Bakshi, SM, VSM expressed concern that in past few years, Delhi is experiencing differentiable shift in the climate like winters are squeezing with each passing year and temperatures staying over 45 degrees C for most part of the year. Scientists world over have attributed this to increase in global temperatures. Unless the general public is sensitized and convinced to take measures/adopt environment–friendly actions at their work places, in their homes; this trend of global warming cannot be arrested.

Mr. M.I. Hussain, Principal, DPS Mathura Road, said that unless preventive strategies are taken in this area, situation may worsen in the coming years.

Members of Management Committee of DPS Society and Parent Reps from Nursery to Class XII were also present to celebrate the World Earth Day.

Over 500 school children participated in the walk and on–the–spot competitions which included:……………

Children displayed the following placards and slogans:

  • Do not burn leaves and let them decompose.
  • Walking is the best medicine
  • The least amount of electricity one uses the better it is.
  • Plant trees to save the mother earth.

Inter school competitions (Painting, Poetry recitation, AD Mad) were also held.

    Readers Response
  1. Dear Sir. Reading eMedinews is joy for ever. Regards:Dr JS Sharma
    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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