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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

23rd March 2013, Saturday

How to eat salt?

As per WHO, one should not take more than 5gm of salt in a day. If salt intake is reduced, the incidence of heart attack, heart failure, will be reduced substantially.

Here are the ways:

  1. Substitute white salt with black salt wherever possible.
  2. Do not keep salt shaker on the table.
  3. Do not add salt in your food except in pulses and cooked vegetables.
  4. Do not add salt to salads.
  5. Avoid adding salt to foods at the table.
  6. Take stock of the sources of salt in your diet, such as restaurant meals, salt-based condiments and convenience foods. Some of these are really loaded with salt.
  7. Read the labels when shopping. Look for lower sodium in cereals, crackers, pasta sauces, canned vegetables, or any foods with low-salt options. Or, eat less processed and packaged foods.
  8. Ask about salt added to food, especially at restaurants. Most restaurant chefs will omit salt when requested.
  9. Remember the word ‘Na’, which is present in many drugs, soda etc.
  10. Nothing can be preserved without adding salt to it, therefore beware of processed and frozen fruits.
  11. Many sweet food items have significant hidden salt in them.
  12. To cook with reduced salt, one can add more lemon, garlic, amchur (mango powder) etc.
  13. It takes three months of salt-free diet to get adjusted to it and to ultimately start liking it.
  14. Never add salt to milk.
  15. Beware of salt in tooth pastes.
  16. Replace sodium with potassium salt.
  17. Achar, papad, chutney traditionally used in Indian diet have very high salt content. Most sauces will also have very high salt content.

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

ACE inhibitors better ARBs in new meta–analysis in hypertensives

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

A symposium on prayer, faith, meditation and healing was organised by Heart Care Foundation of India jointly with Bhartiya Vidya Bhavan at Bhavan’s Auditorium. Speakers from various religions participated in the symposium.

Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India moderated the session

Dr K K Aggarwal
    National News

A Bill Further to attend the Indian Medical Council Act, 1956 by Shri Ghulam Nabi Azad, Minister of health and Family Welfare has been introduce in Rajya Sabha. Kindly read and give views in eMedinewS


Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Violation of human rights

  1. Injustice to humanity
  2. Violation of human rights
  3. Perpetual victimization o Social stigma and social ostracism leading to constant humiliation.

For comments and archives

    Valvular Heart Disease Update

Prosthetic Valve update

Among patients who are not bleeding, those with an INR =6.0 should be admitted to the hospital and warfarin should be temporarily discontinued to permit a gradual reduction in INR. Intravenous vitamin K should not be given because of the risk of valve thrombosis if the INR falls too quickly.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Contrast agent gets FDA OK

The FDA has approved the contrast agent gadoterate meglumine (Dotarem) for use in magnetic resonance imaging of the central nervous system. The agency cleared the agent for use in patients 2 years and older, following the recommendation of an advisory committee that met last month. The committee, which unanimously supported approval in most patients, balked at its use in the youngest children, citing insufficient evidence. (Source: Medpage Today)

Eritoran for severe sepsis does not reduce mortality

Eritoran did not significantly reduce mortality from severe sepsis and septic shock, according to the double-blinded ACCESS randomized trial reported March 20 in JAMA. (Source: Medscape)

Comorbidities affect need for repeat joint surgery

Specific patient characteristics, such as depression and renal disease, can help predict which patients with knee or hip replacements are most likely to need repeat surgery within a year, a researcher reported at the annual meeting of the American Academy of Orthopaedic Surgeons. (Source: Medpage Today)

Cervical screening guidelines updated

New cervical screening guidelines posted online March 21 by the American Society for Colposcopy and Cervical Pathology (ASCCP) now address management of discordant co-tests, in which results of either Papanicolaou (Pap) smear or human papillomavirus (HPV) testing are positive, but not both. The new algorithms update the 2006 recommendations, based on risk analysis of new data from nearly 1.4 million women in a National Cancer Institute–Kaiser Permanente Northern California cohort. (Source: Medscape)

Whole world uses too much salt, study finds

Salt intake worldwide is at least twice what it should be, with a big impact on global health, researchers found. Daily sodium intake averaged 3,950 mg in 2010, according to an analysis covering nearly all of the world's population by Dariush Mozaffarian, MD, MPH, of Harvard School of Public Health, and colleagues. The recommended daily intake is 2,000 mg by World Health Organization standards and 1,500 mg by American Heart Association guidelines. (Source: Medpage Today)

  Twitter of the Day

@DrKKAggarwal: Dr Anil Kumar Singh and Dr Mithleshwar Kumar on IMA AKN Sinha Institute Update: http://youtu.be/HgJ0yIjsY4g?a via @YouTube

@DeepakChopra: To love and be loved is the most natural & spontaneous expression of our being #CosmicConsciousness

    Spiritual Update

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

Shiksha and Sabhyata

Suno, Samjho, Jaano and Karo is the mantra for education and involves not only hearing but listening and understanding and converting understanding into wisdom by doing it practically.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How can the damage to the fallopian tubes be fixed?

The surgeon will try to cut the scars between your fallopian tube and ovary. If one or both tubes are completely blocked, your surgeon can attempt to open the tube. Surgery can be done in one of two ways (laparoscopy or laparotomy). Laparoscopy, or minimally invasive surgery, can be performed. During this procedure a very small camera attached to a thin telescope is inserted through a small incision (surgical opening) below your belly button. The surgery is performed during small tools, which can be inserted through other small incisions across your belly. A traditional open procedure, called a laparotomy, also may be done. In this procedure, the surgery is performed through a large incision made in your belly (abdomen).

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

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

ABO system and pregnancy

The O gene is an amorph and functionally silent.

    An Inspirational Story

Success depends upon maturity!

Maturity is many things. It is the ability to base a judgment on the big picture, the long haul. It means being able to resist the urge for immediate gratification and opt for the course of action that will pay off later.

One of the characteristics of the young is “I want it now.” Grown-up people can wait.

Maturity is perseverance–the ability to sweat out a project or a situation, in spite of heavy opposition and discouraging setbacks, and stick with it until it is finished.

The adult who is constantly changing friends and changing mates is immature. He/she cannot stick it out because he/she has not grown up.

Maturity is the ability to control anger and settle differences without violence or destruction. The mature person can face unpleasantness, frustration, discomfort and defeat without collapsing or complaining. He/she knows he cannot have everything his/her own way every time. He/she is able to defer to circumstances, to other people-and to time. He/she knows when to compromise and is not too proud to do so.

Maturity is humility. It is being big enough to say, “I was wrong.” And, when he/she is right, the mature person need not experience the satisfaction of saying, “I told you so.”

Maturity is the ability to live up to your responsibilities, and this means being dependable. It means keeping your word. Dependability is the hallmark of integrity. Do you mean what you say-and do you say what you mean? Unfortunately, the world is filled with people who cannot be counted on. When you need them most, they are among the missing. They never seem to come through in the clutches. They break promises and substitute alibis for performance. They show up late or not at all. They are confused and disorganized. Their lives are a chaotic maze of broken promises, former friends, unfinished business and good intentions that somehow never materialize. They are always a day late and a dollar short.

Maturity is the ability to make a decision and stand by it. Immature people spend their lives exploring endless possibilities and then doing nothing. Action requires courage. Without courage, little is accomplished.

Maturity is the ability to harness your abilities and your energies and do more than is expected. The mature person refuses to settle for mediocrity. He/she would rather aim high and miss the mark than low-and make it.

Maturity is the art of living in peace with that which cannot be changed, the courage to change that which should be changed, no matter what it takes, and the wisdom to know the difference.

For comments and archives

  Cardiology eMedinewS

Stressed 24-year-old suffers heart attack Read More

Peer coaching improves glucose control in diabetes Read More

  Pediatric eMedinewS

Some aggressive retinoblastomas lack RB1 mutations Read More

Anthrax vaccine testing in children: Strict new guidelines Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

How common are animal bites and infections?

Only 15 to 20 percent of dog bite wounds become infected. Puncture wounds and hand wounds are more likely to become infected than scratches.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with high grade fever with low platelet count came for evaluation.
Dr Bad: Treat him for dengue.
Dr. Good: Also do a tourniquet test and check his PCV.
Lesson: Low platelet count is not the only diagnostic criterion for severe dengue. The classical triad is low platelets, positive tourniquet test and 20% increase in hematocrit.

Make Sure

Situation: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).
Reaction: Oh my God! Why was CAD not ruled out in this case?
Lesson: Make sure that all patients with OSA are investigated for underlying CAD.

  Quote of the Day (Dr GM Singh)

As you get older three things happen. The first is your memory goes, and I can't remember the other two. Sir Norman Wisdom

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    Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. In which situations is it essential to obtain expert medical opinion before proceeding with a complaint of medical negligence?


1. The answer is summarized in the following table.

Forum Type of complaint Whether essential to take expert opinion If yes, whose responsibility is it to take opinion Reference Comm-ents
Consumer court Consumer complaint No NA NA It was mandate by D’Souza case but nullified by Kishan Rao case
Police Police complaint Yes Police Jacob Mathew case, SC Police is not supposed to register FIR in the absence of such opinion
Magistrate’s Court Complaint by a private person to Magistrate

(May be when the police refuses to register FIR)
Yes Private person/complainant Jacob Mathew case, SC Police often violates this.
Civil court Plaintiff (it is really not a complaint but a civil suit) No NA NA Civil suits are now
Medical council Complaint under the 2002 regulations No NA NA Patients go to medical council because they are unable to get other doctors’ testimony against a fellow doctor.

2. The relevant portion of the Jacob Mathew judgment is reproduced below---

“A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor. The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation.”


    Mind Teaser

Read this…………………

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department?

a. Chlamydia
b. Gonorrhea
c. Genital herpes
d. Human papillomavirus infection

Yesterday’s Mind Teaser: For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?

a. Encouraging coughing and deep breathing
b. Promoting carbohydrate intake
c. Limiting fluid intake
d. Providing pain-relief measures

Answer for Yesterday’s Mind Teaser: c. Limiting fluid intake

Correct answers received from: Dr. B.B. Gupta, Prabha Sanghi, Tukaram Pagad, Dr. Thakor Hitendrsinh G, Dr. P. C. Das, Anil Bairaria, DR ARPAN GANDHI , Dr Pankaj Agarwal, drjella, Muthumperumal Thirumalpillai, Dr Kanta Jain, Dr B K Agarwal

Answer for 21st March Mind Teaser: a. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

Correct answers received from: Dr. P. C. Das, Anil Bairaria, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta Jain, Dr B K Agarwal

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Spring Fever

Four high school boys afflicted with spring fever skipped morning classes. After lunch they reported to the teacher that they had a flat tire.

Much to their relief she smiled and said, "Well, you missed a test today so take seats apart from one another and take out a piece of paper."

Still smiling, she waited for them to sit down. Then she said: "First Question: Which tire was flat?"

    Medicolegal Update

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

A Criminal Investigative model of FBI for lust murders

On the basis of various literature and experience of two decades, I endorse/feel that dead bodies do tell tales as to ‘how he/she has been killed/died"; what is required is a meticulous autopsy surgeon to hear/understand its language.

Lust murder may be organized or disorganized depending on the psychopathology of the offender and the same is manifested in the crime scene of the killings.

It is determined by very close observation/examination of the scene and corpse. In the case of a disorganized offender, the victim will be immediately rendered unconscious or dead by a "blitz–style" of attack and there will be evidence of symbolic and postmortem sexual activities.

In both instances, however, the cutting, mutilation and overkill type wound structures will be directed towards those parts of the body that the offender finds significant to him as per his fantasy and serve as a sexual stimulus.

The disorganized offender usually depersonalizes his victim by facial destruction or overkill type of wounds and it became a signature forensic component for crime detection.

Any sexually sadistic acts are performed postmortem. Mutilation to the genitalia in females, neck, throat and buttocks are performed because these parts of the body contain a strong sexual significance to him. Most cases of lust murder usually involve male perpetrators. However, accounts of female lust murderers do exist also.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Hospitals must have a prayer room

Inaugurating a symposium on prayer, faith, meditation and healing, Prof. B.M. Hegde, Chairman Bhartiya Vidya Bhavan, Mangalore Kendra said that every hospital should have a prayer room where people from every religion can pray.

The symposium was organised by Heart Care Foundation of India jointly with Bhartiya Vidya Bhavan at Bhavan’s Auditorium and was participated by speakers from various religions.

Moderating the session, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that often doctors get request from the patients and/or their relatives either to let them pray or have the doctors pray for them or with them. There are studies which show that prayer has a positive healing effect.

Dr. Aggarwal said that both prayer and meditation shift one from sympathetic to parasympathetic mode and helps in healing. Positive faith in doctors and drugs also has a healing effect.

In a joint statement, Mr. Ashok Pradhan, Mr. G C Garekhan, Mr. J Veeraraghavan from Bhartiya Vidya Bhavan said that spiritually religions and cultural beliefs always play significant role in the lives of patients who are seriously ill and dying. They said that the wishes of the dying patients and their relations should be respected and their spiritual needs must be taken care of.

On the subject of praying with the patients, Rev. Ivan Moses said that in Christianity, the dying patient’s request for the healthcare professional to pray with him or her is usually honored. If the doctor is uncomfortable with the request to pray with the patient, he or she can sit by in silence as the patient prays in the patient’s language and tradition.

Maulana Dr. Mufti Mohammad Ahmad said that in Islam, doctors may pray for patients and they are encouraged to. Islam also believes that patients should not only pray for themselves but also for other fellow patients.

Prof. Sunil Kumar and Dr Nirmal Jit Singh said that in Hinduism and Sikhism there are no specific guidelines issued to physicians praying together with the patients. But both religions believe in prayers when the person is sick.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 31175 people since 1stNovember 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Response
  1. Dear Dr. KK Aggarwal, eMedinewS is a boon for doctors. Being a surgeon I wasn’t in touch with medicine since long but eMedinewS keeps me updated and brush up other old concepts read earlier. Thanks: Dr. CM Sharma.
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