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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 …

21st August 2011, Sunday

What makes a wave?

As we have been witnessing over the last few days, there is an ‘Anna wave’ in the country. People of all ages, from all walks of life have come out on the streets in large numbers in support of Anna Hazare. Till about few months back, Anna Hazare was a relatively unknown name to most people. Since then, he has become the biggest name in the country. A new term has been coined. Just like Gandhigiri, Annagiri is the talk of the town.

What is the reason for this wave of support? Why has there been such an upsurge of people?

The success of a wave depends on the subject and is based on the principles of truthfulness, non violence and sarvodaya i.e. welfare for all. Anna Hazare stands for all these three principles.

For a wave to spread across the entire nation, it must cover one percent of the population. This can be explained by the 100th–monkey phenomenon.

"Long time back there was a monkey called Emo in a far off village in Japan. Monkeys at that time used to eat apples lying in the gardens full of dust. One day Emo by mistake washed the apple in the pond before eating. From then onwards he washed every apple he ate. The message went from one monkey to the second monkey and then to the third and so on. Many monkeys started washing apples before eating. After sometime, some neighboring monkeys from other villages also started washing their apples before eating. The day the 100th monkey washed the apple and ate it, a strange phenomenon was observed all over the country. Monkeys all over the country started washing apples before eating. The critical mass in that area therefore was 100. Once the critical mass was achieved, the information spread like wildfire to each and every monkey and everybody started washing apples before eating."

In campaigning also the politicians make use of this principle and make sure that the critical mass is achieved to start with. In local political meetings also, the same principle of 1% critical mass is used. For a gathering of 1000 people, politicians make sure that they have minimum 10 of their own people are sitting in the audience to initiate clapping. When 10 people clap, the rest 990 will also follow and clap. Similarly, for a gathering of 2000 they will need 20 people and for 10,000 they will need 100 people.

When you want to pass on a message to the audience, it has to be flashed for at least 10 seconds. The mind cannot remember what it had seen or heard for less than 10 seconds. The politicians will highlight what they want to say and pass on hurriedly what they do not want the people to remember.

If Anna Hazare is able to capture one percent of the people, which he appears to have achieved, then this movement would become nationwide. This critical mass of one percent, once achieved, is the reason why ideas and movement spontaneously spread among the general population.

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What makes a wave?

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medicolegal Issues

Dr Arvind Chopra being felicitated in the National Conference on Insight on Medicolegal Issues held on 10th July, 2011.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Unclean coolers breeding Aedes

Here’s some cold comfort for thousands in the grip of viral fever in Jamshedpur and its outskirts. A four–member team from the Ranchi wing of National Malaria Research Institute (NMRI), New Delhi, which had been camping in the steel city since August 8, has zeroed in on an unexpected breeding ground of vectors — unattended air coolers. State officer in charge of NMRI M.K. Das, who lead extensive studies in the worst–affected pockets of Mango and Bagbera on Thursday, has told East Singhbhum civil surgeon Vibha Sharan that the pandemic diseases of chikungunya and dengue are linked to stagnant water in containers, largely air coolers, in these residential areas. Speaking to The Telegraph, Das said they had also found that 80–90 per cent mosquitoes stalking the city were of the Aedes aegypti variety, the vector known to spread chikungunya and dengue viruses. (Source: The Telegraph, August 19, 2011)

For comments and archives

Nine more test positive for scrub typhus in Shimla

Nine patients suffering from scrub typhus, a disease caused by the bite of an infected mite, have been reported in Shimla. "Nine more patients tested positive for scrub typhus Wednesday," Indira Gandhi Medical College and Hospital (IGMCH) medical superintendent K.S. Rana said in Shimla. Seventy–three patients suffering from the disease have been reported in the IGMCH this year, he said, and added that the arrival of scrub typhus patients would continue till end of October. Forty–four deaths were reported in the state in the past two years due to the disease. However, in the IGMCH no death has been reported so far. "As many as 1,206 scrub typhus cases were reported in the state in the last two years. Of these, 948 cases were reported last year," state Health Minister Rajeev Bindal informed the assembly March 31. He said 27 patients died in 2010 whereas 17 died in 2009 due to the disease. The symptoms of the disease include fever, headache, muscle pain, cough and gastroenteritis (inflammation of the mucous membrane of the stomach and intestines). (Source: Hindustan Times, August 18, 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

(Dr Monica and Brahm Vasudev)

Malpractice: Many claims but few big paydays

Over the course of a career, most physicians will face at least one malpractice claim, but the likelihood of litigation is much greater for neurosurgeons than it is for psychiatrists –– and about three out of every four malpractice claims are resolved with no payment to the plaintiffs. Among specialties with a high risk of a malpractice claim –– usually surgical specialties –– nearly all physicians (99%) will have a malpractice claim by the time they turn 65, Amitabh Chandra, PhD, of Harvard University, and colleagues wrote in the Aug. 18 issue of the New England Journal of Medicine (Source: Medpage Today)

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Comorbidities tied to postop risk of death in IBD

Among patients with inflammatory bowel disease (IBD) who are undergoing bowel surgery, the likelihood of dying in the hospital increases the more comorbidities they have, researchers found. For patients with no comorbid conditions, the postop mortality rate was 0.4%; with one comorbidity, it was 1.5%, according to Gilaad Kaplan, MD, MPH, of the University of Calgary in Alberta, and colleagues. (Source: Medpage Today)

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Nocturnal ACS linked to belly fat, disordered sleep

Nighttime acute coronary syndrome (ACS) occurred significantly more often in patients with visceral fat accumulation and sleep–disordered breathing, investigators reported. Among 25 patients with nighttime onset of ACS, two–thirds of those with ≥100 cm2 of visceral fat accumulation also had sleep–disordered breathing as compared with a fourth of patients with less visceral fat. (Source: Medpage Today)

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    Fitness Update

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

Only 12% of high school students get enough exercise

Two new reports provide a snapshot of the physical activity and beverage habits of U.S. high school students. About one in 10 high school students gets the recommended amount of aerobic and muscle–strengthening exercise, and nearly a quarter of students drink at least one sugary soda every day. Both reports, which appear in the CDC’s Morbidity and Mortality Weekly Report, analyzed data from the 2010 National Youth Physical Activity and Nutrition Study that looks at the height/weight, diet, and exercise habits of high school students.

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    Twitter of the Day

@DrKKAggarwal: #IJMD Endodontic therapy has made deep inroads into every sophisticated dental practice today. Abilash et al Vol 1… fb.me/HCkBkVLI

@DeepakChopra: Bid on a pair of hand painted personally autographed converse for the Chopra Foundation by @canvaswarriors

    Dr KK Answers

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

How common is obesity in young heart patients?

Obesity is an independent risk factor and is linked with abdominal obesity. Fatty liver is usually present.

For comments and archives

    Spiritual Update

Satyagraha is not same as strike

The recent Anna movement has opened a pandora of alternatives for fighting justice. From time immemorial people have been fighting for justice.

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    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

The true winner

This is a true story that had happened in 1892 at Stanford University. Its moral will always be relevant.

A young, 18–year–old student was struggling to pay his fees. He was an orphan, and not knowing where to turn for money, he came up with a bright idea. A friend and he decided to host a musical concert on campus to raise money for their education. They reached out to the great pianist Ignacy J. Paderewski. His manager demanded a guaranteed fee of $2000 for the piano recital. A deal was struck. And the boys began to work to make the concert a success.

The big day arrived. Paderewski performed at Stanford. But unfortunately, they had not managed to sell enough tickets. The total collection was only $1600. Disappointed, they went to Paderewski and explained their plight. They gave him the entire $1600, plus a cheque for the balance $400. They promised to honour the cheque soonest possible. "No." said Paderewski. "This is not acceptable." He tore up the cheque, returned the $1600 and told the two boys "Here’s the $1600. Please deduct whatever expenses you have incurred. Keep the money you need for your fees. And just give me whatever is left" The boys were surprised, and thanked him profusely.

It was a small act of kindness. But it clearly marked out Paderewski as a great human being. Why should he help two people he did not even know? We all come across situations like these in our lives. And most of us only think "If I help them, what would happen to me?" The truly great people think, "If I don’t help them, what will happen to them?" They don’t do it expecting something in return. They do it because they feel it’s the right thing to do.

Paderewski later went on to become the Prime Minister of Poland. He was a great leader, but unfortunately when the World War began, Poland was ravaged. There were over 1.5 million people starving in his country, and no money to feed them. Paderewski did not know where to turn for help. He reached out to the US Food and Relief Administration for help. The head there was a man called Herbert Hoover – who later went on to become the US President. Hoover agreed to help and quickly shipped tons of food grains to feed the starving Polish people. A calamity was averted.

Paderewski was relieved. He decided to go across to meet Hoover and personally thank him. When Paderewski began to thank Hoover for his noble gesture, Hoover quickly interjected and said, "You shouldn’t be thanking me Mr. Prime Minister. You may not remember this, but several years ago, you helped two young students go through college in the US. I was one of them."

The world is a wonderful place. What goes around comes around !

For comments and archives

    Gastro Update

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

How do you treat Hepatitis C in children?

Accumulating evidence supports the use of combination therapy with pegylated interferon and ribavirin to treat chronic hepatitis C infection in children. In a multicenter trial, this combination yielded 93 percent sustained viral response in patients with genotype 2 or 3, and 53 percent in those with genotype 1. The decision of whether to treat chronic hepatitis C depends on the child’s age, genotype, and liver histopathology.

(Ref: Wirth S, Ribes–Koninckx, C Calzado MA, et al. High sustained virologic response rates in children with chronic hepatitis C receiving peginterferon alfa–2b plus ribavirin. J Hepatol 2010;52:501).

For comments and archives

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Increased: Renal failure including prerenal, drug–induced (aminoglycosides, vancomycin, others), acromegaly.
Decreased: Loss of muscle mass, pregnancy.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with egg allergy came for the ‘flu’ shot.
Dr. Bad: Sister! give it.
Dr. Good: It cannot be given.
Lesson: The only contraindication to vaccination is an anaphylactic hypersensitivity to eggs, or other components of the vaccine.

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Make Sure

Situation: A patient with unexplained fever developed perforation of the small intestine.
Reaction: Oh my God! Why was typhoid not suspected in this case?
Lesson: Make sure that a diagnosis of typhoid is kept as a possibility in every case of PUO.

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  Quote of the Day

(Dr Chandresh Jardosh)

The secret of a good life is to have the right loyalties and hold them in the right scale of values. Norman Thomas


(Ms Ritu Sinha)

An arm and a leg: Very expensive. A large amount of money.

    G P Pearls

(Dr Pawan Gupta)

Fluticasone is twice potent than budesonide.

    Medicolegal Update

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

What is a negative postmortem examination?

Negative or obscure autopsy is important in cases where no significant finding are discovered in autopsy

  • When in a postmortem examination all efforts means macro/gross, microscopic chemical and toxicological result couldn’t be concluding enough into cause, manner or other required medico–legal aspect of death then the obscure or negative autopsy work for logical conclusion.
  • Negative autopsy is very useful in cases where there is no adequate history of death.
  • Death from fear/fright or shock/Cases of post fracture air embolism.
  • Death due to lesion in neck as diphtheria, laryngeal bronchitis/swelling of glottis or choking on food.
  • Cases like brown atrophy of heart associated with starvation, asthma or cancer.
  • Sickle cell disease/Lesion of adrenal gland/hemorrhage or destruction by tumor.
  • The negative autopsy is also very informative as witnessed by me in death due to distal coronary artery occlusion or coronary artery spasm.

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    Mind Teaser

Read this…………………

The main site of bicarbonate reabsorption is:

1. Proximal convoluted tubule
2. Distal convoluted tubule
3. Cortical collecting duct
4. Medullary collecting duct

Yesterday’s Mind Teaser: Which of the following catheter materials is most suited for long–term use is?

1. Latex
3. Rubber
4. Polyurethane

Answer for Yesterday’s Mind Teaser: 2. Silicone

Correct answers received from: Dr Ravisekar Vasudevan, Dr Gaganpal Singh, Dr Rajshree Aggarwal, Dr Chandresh Jardosh, Dr Prabodh Kumar Gupta, Dr Sudhir Khanna, Dr Anil Bairaria, Dr Jainendra Upadhyay, Dr Surendra Bahadur Mathur, Dr Valluri Ramarao.

Answer for 19th August Mind Teaser: 2. Primary repair
Correct answers received from: Dr Sukanta sen, Dr Surya P Sethi, Dr BB Aggarwal, Dr Pallipalayam Sivaramakrishnan Regavan.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

Funny definition from a Science exam

The body consists of three parts – the brainium, the borax, and the abominable cavity. The brainium contains the brain; the borax, the heart and lungs; and the abominable cavity, the bowls, of which there are five – a, e, i, o, and u."

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Tiapride Hydrochloride Tablets 25mg/50mg/100mg
For the treatment of agitation and aggressiveness in adult patients with cognitive impairment.
    Public Forum

(Press Release for use by the newspapers)

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Janmashtami is not about eating butter and butter oils.

Janmashtami is a festival to spread love and not eating butter, butter oils and trans fats said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela. A 1% rise in total and or bad LDL cholesterol increase the chances of heart attack by 2%; also, a 1% reduction in the good HDL cholesterol increases the chances of heart attack by 3%.

Heart patients, diabetics and obese people should not eat butter this Janmashtami, a festival to spread love and happiness and not eating butter, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

One teaspoonful of butter contains 25 mg cholesterol. Butter and butter oil contain saturated fats which can be harmful to the heart.

Any fat of plant in origin has no cholesterol. Only foods that are of animal origin contain cholesterol. Butter and butter oil being animal in origin are high in cholesterol and saturated fats.

Fats that are solid at room temperature are saturated and those that are liquid at room temperature are unsaturated. It is the saturated and the trans saturated fats which increase the bad LDL cholesterol. A 1% increase in total and or bad LDL cholesterol increase the chances of heart attack by 2%.

Trans fat is just as bad. Hydrogenated oils available as vanaspati contain trans fats and are worse than butter. They increase the bad LDL cholesterol and reduce the good HDL cholesterol. A 1% reduction in good HDL cholesterol increases the chances of heart attack by 3%.

Chocolate is equally bad as it contains refined sugar and can increase insulin resistance and makes one more prone to develop diabetes and abdominal obesity.

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    Readers Responses
  1. Respected Dr Aggarwal sir please guide me at what stage we should advice hunger striker to take feed and at what stage we should say if he continues hunger strike it will endanger his life? Dr Sandeep

    Dr KK Aggarwal responds
    Appearance of ketones in the urine means fat is breaking down. Till the fat in the body is up to 7% in males am 10% in females there is no risk to life. Below that fat levels the effects of starvation and muscle wasting starts due to proteins breakdown. Clinically patients will present with an intense desire to eat. At this time the hunger stroke should be broken.
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.



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