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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 (07–08c); 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 Workshop on Stress Management and How to be Happy and Healthy

  Editorial …

23rd May 2012, Wednesday

Treatment for constipation in the elderly

In patients over of 70 years being treated with enemas for constipation water enemas should be used rather than sodium phosphate enemas

The commonly used treatment for constipation is sodium phosphate enemas. There is evidence that the use of sodium phosphate enemas may be associated with serious adverse events.

In a retrospective series, the use of sodium phosphate enemas in older adults for constipation was associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo–or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure and EKG changes (prolonged QT interval).

Preparation for flexible sigmoidoscopy also involves sodium phosphate enemas. Here, also one should use polyethylene glycol lavage or magnesium citrate) for each individual patient before deciding upon an appropriate preparation. (Arch Intern Med 2012;172:263)

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Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Treatment for constipation in the elderly

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Bimari ek Ilaaj anek

An All pathy consensus organized by Heart Care Foundation of India in association with All India Radio

Dr K K Aggarwal
    National News

Physios want council on lines of Medical Council of India

NEW DELHI: The Indian Association of Physiotherapists (IAP) has reiterated its demand for the formation of an independent central physiotherapy council on the lines of Medical Council of India (MCI) and Dental Council of India (DCI). According to the IAP, in the absence of a regulatory body, there is no check of quality of education provided to the students aspiring to join the profession and there is crisis of jobs as well. "Out of 250 colleges that offer physiotherapy course in India, about 100 have been closed down in the last five years due to lack of opportunities. In Delhi, four colleges have shut down the physiotherapy department recently because number of students seeking to take admission in the course remained low," said Koshy K Mathai, executive member, IAP. (Source: TOI, May 21, 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

(Contributed by Dr Monica and Brahm Vasudev)

Guidelines now available for CT lung cancer screening

Guidelines for lung cancer screening with computed tomography (CT) are now available to clinicians. They were developed by the American College of Chest Physicians (ACCP) and the American Society for Clinical Oncology (ASCO), and endorsed by the American Thoracic Society (ATS). They were published online May 20 in JAMA. The guidelines recommend annual screening with low–dose CT for smokers and former smokers 55 to 74 years of age who have smoked for 30 pack–years or more, and who either continue to smoke or who have quit within the past 15 years (grade 2B recommendation). Screening is not endorsed for people who have accumulated fewer than 30 pack–years of smoking, are either younger than 55 years or older than 74 years, and have not smoked for more than 15 years. Screening is not recommended for people with severe comorbidities that preclude potentially curative treatment and/or limit life expectancy (grade 2C recommendation). (Source: Medscape)

For comments and archives

Microscopic hematuria not predictive of cancer

In patients with urinary tract cancer without a history of gross hematuria, the degree of microscopic hematuria did not accurately predict the presence of cancer, according to the findings of a prospective study conducted in a managed care organization. (Source: Medscape)

For comments and archives

Dyspnea Tx alike in malignant pleural effusions

Two treatment approaches to the disabling shortness of breath associated with malignant pleural effusions appeared to be equivalent in a randomized trial, researchers are reporting. (Source: Medpage Today)

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FDG–PET contributes to staging of localized gastric cancer

Preoperative 18F–fluorodeoxyglucose positron emission tomography (FDG–PET) can significantly contribute to staging of locally advanced gastric cancer, according to researchers at Memorial Sloan–Kettering Hospital and Weill Cornell Medical Center, both in New York City. (Source: Medscape)

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Devices dominate guidelines for heart failure

Lifestyle is out and devices are in for acute and chronic heart failure management, according to a major revision of European guidelines. Lifestyle and nonpharmacologic recommendations have historically been included in the guidelines developed by the European Society of Cardiology and the Heart Failure Association, despite poor levels of evidence that those management techniques worked. In the new version, updated from 2008, exercise and care in a multidisciplinary program are the only lifestyle recommendations that remain. (Source: Medpage Today)

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    Twitter of the Day

@DrKKAggarwal: Guidelines out for diagnostic cath use The explosion of advanced cardiovascular diagnostic technology has… http://fb.me/ErNvU6gG

@DeepakChopra: Pursue excellence, ignore success

    Spiritual Update

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

Suno Samjho Jaano Karo

When I see a spiritual Guru as a patient I always request them to give me some Seekh (blessing). Once one of my anesthetist colleagues brought a spiritual Guru to me and when I asked him for a seekh, he said 4 words, "Suno, Samjha, Jaano, Karo". Later I realized that it was the best blessing I could have got from a spiritual Guru as a

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    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the psychological aspects of hirsutism and PCOS?

Dealing with hirsutism and PCOS can be emotionally difficult. You may feel unfeminine, uncomfortable, or self–conscious about your excessive hair growth or weight, as well as worry about your ability to have children. Even though you may be embarrassed to share these feelings with other people, it is very important that you talk to your physician as soon as possible to explore the medical and cosmetic treatments available to treat these disorders.

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

(Dr Sanjay Chaudhary, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre, Daryaganj, New Delhi)

Q. Does eye donation disfigure the donor’s face?

A. No. The removal of corneas/eyes does not cause disfigurement.

Q. Is there any delay in funeral arrangements?

A. No. Tissue procurement is performed within 20 to 30 minutes. Therefore, family members of the deceased may proceed as planned with funeral arrangements.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

A sincere man’s promise

This is a true story about two friends. One day a young man said to his good friend, "I can see that someday you will become great and rich."

His friend scoffed, "Ridiculous! How will I become a great and rich man?" The first friend said, "Yes, I can see it. It is written on your forehead." The second one said, "All right, if I become great and rich, I will give you ten thousand rupees." "Do you really mean it?" the first friend asked. "If so, then write it down." The second one wrote down, "I will give you 10,000 rupees if ever I become rich and great," and he signed his name.

The young man kept the note that his friend had written, but he never took his friend seriously. The agreement was made as a joke. Now, it happened that in 10 or 12 years the one friend really did become rich and great, while the other unfortunately remained quite poor. By that time both friends had drifted apart and were leading their own lives. Even so, the poor friend continued to preserve the note, although he felt that since it was a joke, he would never receive the money.

Quite unexpectedly, the poor man fell seriously ill. Just before he died, he called his son, who was only seven years old, and said to him, "My son, please bring me the box that is near the window. Inside it there is something very precious that I have kept for you."

The son was so sad that his father was dying that he did not want to bring the box. He felt that nothing could be more precious than his father’s life. But the father insisted, so the son went and got the box. Then the father said, "When I die…" and immediately the little boy and his mother started crying. But the father continued, "After I die, you go to this man and show him what he has written." The wife and son looked at the paper and were surprised to learn that the rich man had promised to give his friend ten thousand rupees. But at that moment they could think of nothing but their beloved who was about to leave them.

Soon the man died. Their friendship had faded so much that the rich man, who was once the poor man’s best friend, did not even come to see him before he left this world. But after three or four weeks’ time the son took the note to the rich man. The rich man had many servants. At first they didn’t want to allow this little boy to bother their master. But finally, when they saw he was only an innocent child, they allowed him to come in. The boy gave the rich man the note. The rich man read it and asked, "Did I write this?"

The boy said, I do not know. Before he died, my father gave it to me to give to you." The son was near tears. The rich man summoned one of his secretaries and explained, "I promised this boy’s father many years ago that I would give him 10,000 rupees if I became rich and great. I have been rich for seven years; please calculate how much interest I have to give him in addition to the 10,000 rupees." The secretary told him, "An additional 7,000 rupees, which makes it 17,000 altogether."

The rich man immediately issued a check for 17,000 rupees and gave it to the little boy, saying, "Take this directly to your mother. Don’t go anywhere else first." This is how one sincere man kept his promise.

For comments and archives

    Cardiology eMedinewS

‘Parachute’ Promising For Heart Failure Read More

One Troponin Test To Identify Low–Risk Patients Fast Read More

Exercise Slows Muscle Loss in CHF Patients Read More

Risk Plays Little Role in Stress Test Orders Read More

    Pediatric eMedinewS

FDA Proposal Aims At Lower Doses For Pediatric X–Ray Read More

FDA Approves Addition Of 3 Bacteria To Respiratory Panel Read More

Prevalence of NAFLD Increasing Among American Adolescents Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine and palpitations came for treatment.
Dr. Bad: No drug is needed.
Dr. Good: Take verapamil.
Lesson: Verapamil is frequently used as a first choice for preventive migraine therapy because it is easy to use and has few side effects.

For comments and archives

Make Sure

Situation: A 19–year–old boy came to the clinic with complains of rectal pain, tenesmus and bleeding per rectum. He gave the history of anorectal intercourse. Rectal culture was positive for Chlamydia trachomatis.
Reaction: Oh my God! Why did you not prescribe macrolides?
Lesson: Make sure to remember that treatment with single dose of 1 g azithromycin is effective in treatment of LGV proctitis.

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  Legal Question of the day

(Prof. M C Gupta, Advocate & Medicolegal Consultant)

Q. Does MCI have a clause to prevent doctors from practicing two specialities simultaneously? For example, if one has degrees in Medicine and Radiology, can he practice both simultaneously?

There is no such bar. Such bar would have been illogical and illegal. A person qualified in two fields can certainly practice in both the fields. As a matter of fact, persons with expertise in two fields can and do make important contributions to interdisciplinary research and development of new specialties. There are specialties like neuroendocrinology and neuropsychiatry, which clearly involve multiple specialties.

For comments and archives

  Quote of the Day

(Dr GM Singh)

‘Tis the set of the sail that decides the goal, and not the storm of life. Ella Wheeler Wilcox

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Prolactin estimation should only be done with a mid morning pooled sample i.e. 3 samples taken at 20 minutes interval. A single sample can give an erroneous reading.

    Mind Teaser

Read this…………………

Karen has been diagnosed with aplastic anemia. The nurse monitors for changes in which of the following physiologic functions?

a. Bowel function
b. Peripheral sensation
c. Bleeding tendencies
d. Intake and output

Yesterday’s Mind Teaser: What is the peak age range of developing acute lymphocytic leukemia (ALL)?

a. 4 to 12 years
b. 20 to 30 years
c. 40 to 50 years
d. 60 to 70 years

Answer for yesterday’s Mind Teaser: a. 4 to 12 years

Correct answers received from: Dr Sushma Chawla, Prabha Sanghi, Yogindra Vasavada, Dr Jella,
Dr Thakor Hitendrsinh G, Dr Kanta Jain, Dr Chandresh Jardosh, Dr Avtar Krishan, Prof Chetana Vaishnavi, Raju Kuppusamy, Dr Jainendra Upadhyay, Anil Bairaria.

Answer for 21st May Mind Teaser: Sheep and Horses

Correct answers received from: Dr Sushma Chawla, Anil Bairaria, Dr Amol Hartalkar, Dr B Rajammal, Sudipto Samaddar.

Send your answer to ijcp12@gmail.com

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, Gurgaon)

Vaccine preventable diseases and vaccinations

Safety is one of the most important factors and priority in immunizations. Vaccines are not a "one size fits all" mechanism, which is why vaccine research, development, and use is a very complex and contains a wide array of checks for safety. Sometimes vaccines have to be country–specific as the microbe causing the disease may be specific to a country and vaccine developed for one country may not be effective for the other country. Safety and efficacy checks for the vaccine even after a vaccine has been licensed and is in use have to go on through diligent and continuous monitoring and evaluation. Sometimes there may be some new information, which needs to be communicated for better efficacy and better delivery of vaccines (e.g. development of multivalent vaccines). The field of immunization and vaccines is dynamic.

For comments and archives

    Laugh a While

(Dr GM Singh)

The Cardiologist and the Motorcycle repairman

A motorcycle mechanic was removing cylinder–head from the motor of a Harley–Davidson when he spotted a well–known cardiologist in his shop. The cardiologist was there waiting for the service manager to come and take a look at his bike when the mechanic shouted across the garage, ‘Hey Doc, want to take a look at this?’ The cardiologist, a bit surprised, walked over to where the mechanic was working on the motorcycle.

The mechanic straightened up, wiped his hands on a rag and asked, ‘So Doc, look at this engine. I opened its heart, take the valves out, repair any damage, and then put them back in, and when I finish, it works just like new. So how come I make $39,675 a year and you make $1,695,000 when you and I are doing basically the same work?’

The cardiologist paused, leaned over, and then whispered to the mechanic. ‘Try doing it with the engine running’.

    Medicolegal Update

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

What are the cases that should be regarded as medicolegal?

The following cases must be labeled as medicolegal by the treating doctor and medicolegal report should be prepared for further legal investigation

  • All injury/hurt cases, circumstances of which suggest commission of offence by someone
  • All traffic vehicular, railways, aeroplane, ship, boat, factory, construction site or other unnatural accidents
  • Self–inflicted injuries/attempted suicide
  • Cases of criminal abortion
  • Accidents where there is likelihood of death or grievous hurt
  • All cases of suspected or evident poisoning
  • Suspected or evident homicide, suicide including attempted
  • All burn injuries, whatever the cause of burn
  • All suspected or evident sexual assaults
  • All suspected or evident criminal abortion
  • Unconscious cases where the cause is not natural or not clear
  • Cases referred by Courts for age estimation
  • Cases brought dead with improper medical history
  • Dead on arrival cases or patients who die shortly after being brought to the hospital before a definite diagnosis can be made
  • Patients dying suddenly after parenteral administration of a drug or medication
  • Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital
  • Death on the operation table
  • Unexplained death after surgery or interventional procedure
  • Unexplained ICU death
  • Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.
  • Relatives of the patient assault the treating doctor or other staff of the hospital.
  • Any other case not falling under the above mentioned category but has legal implications like medical examination of arrested accused without consent of person.

In case of death of a medicolegal case, the treating doctor has to only handover the body to the concerned police officer with written recommendation for medicolegal (Forensic) autopsy in final death summary/discharge report and a receipt must be obtained for record.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Add fiber to the diet only slowly

Fiber is a plant substance that is required for a healthy diet. Lots of fiber is needed each day to help reduce the risk of heart disease, improve digestion, prevent constipation and maintain a healthy body weight, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India.

Fiber can be found in fruits, whole grains and vegetables. Most adults should eat at least 20 to 35 grams of fiber every day; though the doctors say most people only eat about half as much. It’s best to slowly increase the fiber in your diet instead of piling it on all at once. A sudden increase in fiber intake can cause abdominal discomfort.

Fiber intake should be at least 14 grams per 1000 calories daily; higher fiber intake may improve glycemic control. Saturated fat should be less than 7 percent of calories and there should be minimal trans fat. Total cholesterol should be less than 200 mg daily.

There is an average fall of 1.2/1.3 mmHg blood pressure with average 10 gram intake of fiber.

Certain soluble fibers (psyllium, pectin, wheat dextrin and oat products) reduce bad LDL cholesterol. Every gram increase in soluble fiber reduces LDL cholesterol by an average of 2.2 mg/dL. The message is incorporation of greater amounts of fiber, in which carbohydrate is derived from unprocessed whole foods.

    Readers Responses
  1. Dear friends, several companies have brought out vitamin D in sachet forms in the market apart from the ones mentioned in the text here. I am not mentioning them lest it may sound advocating for them. Each sachet contains 60,000 IU vitamin D. One can choose any one of them. Best wishes: Dr MMA Faridi.
    Forthcoming Events
Dr K K Aggarwal


All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

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

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

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  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta