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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 …

23rd August 2011, Tuesday

In what direction would Anna’s fast end?

Most Satyagraha should end up in a win–win situation. No party should seem to look that they have won. What can happen during a Satyagraha?

  1. The fast is broken after demands are met.
  2. The demands are not met but the fast is broken on the promises made.
  3. The demands are not met but the fast is broken after a committee is constituted to look into the demands.
  4. The fast is broken on the mediation by a religious or an important person in the society.
  5. The fast is broken after the President of the country intervenes.
  6. The fast is broken on medical grounds.
  7. The fast is broken by the order of a court.
  8. The fast is broken on the intervention of local administration or the local police.
  9. The fast is broken on the request of the followers.
  10. Some shift from complete fast to a relay fast.

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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

Acetone in the urine means fat is used as a
source of energy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

23rd Bharat Nirman Award function

Celebrity guests who graced the occasion of the 23rd Bharat Nirman Award function.

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


Lokpal Bill–How Effective To Curb Corruption

The stark truth of modern India is that we are living and surviving a giant pandemic of corruption, scams and all kinds of financial misdemeanours. Corruption is like the ubiquitous virus permeating the entire system. Even the Government machinery is not spared. The Corruption virus is highly resistant to and easily evades all the existing law and order of the land. …..more

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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)

Healthy living really does postpone mortality

A low–risk lifestyle, with an emphasis on healthy eating and being active, has a "powerful and beneficial" effect on mortality, CDC researchers found. People who practiced four low–risk behaviors –– not smoking, eating healthy, getting enough exercise, and drinking alcohol moderately –– were 63% less likely to die within the 18–year study period than those who kept none of those practices, Earl Ford, PhD, of the CDC in Atlanta, and colleagues reported online in the American Journal of Public Health. (Source: Medpage Today)

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Women who abandon HRT skip screening Mammo too

Some women under age 64 who ditched hormone replacement therapy (HRT) because of its potential links with breast cancer also stopped screening mammography, researchers found. Women ages 50 to 64 had lower breast cancer screening rates after they stopped taking HRT, Nancy Breen, PhD, of the National Cancer Institute in Rockville, Md., and colleagues reported online in Cancer. (Source: Medpage Today)

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Heat signature aids TB diagnosis

Tiny amounts of heat given off by tuberculosis bacteria as they grow could be the key to a rapid diagnostic test that poor countries can afford, researchers said. Isothermal microcalorimetry measurements were as effective at detecting TB–causing mycobacteria as conventional culturing methods and much faster, reported Olivier Braissant, PhD, of the University of Basel in Switzerland, and colleagues. Fast–growing species were detected in about one to two days with the microcalorimetry, although it took up to 12 days to identify slower–growing organisms, the researchers said online in the Journal of Applied Microbiology. (Source: Medpage Today)

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    Fitness Update

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

Startling new truth about sugar

Flying in the face of years of scientific belief, University of Illinois researchers have demonstrated that sugar doesn’t melt, it decomposes. "This discovery is important to food scientists and candy lovers because it will give them yummier caramel flavors and more tantalizing textures. It even gives the pharmaceutical industry a way to improve excipients, the proverbial spoonful of sugar that helps your medicine go down," said Shelly J. Schmidt, a University of Illinois professor of food chemistry.

In a presentation to the Institute of Food Technologists about the importance of the new discovery, Schmidt told the food scientists they could use the new findings to manipulate sugars and improve their products’ flavor and consistency. The scientists determined that the melting point of sugar was heating–rate dependent.
"We saw different results depending on how quickly we heated the sucrose. That led us to believe that molecules were beginning to break down as part of a kinetic process," she said. Schmidt said a true or thermodynamic melting material, which melts at a consistent, repeatable temperature, retains its chemical identity when transitioning from the solid to the liquid state. She and Lee used high–performance liquid chromatography to see if sucrose was sucrose both before and after "melting." It wasn’t. "As soon as we detected melting, decomposition components of sucrose started showing up," she said.

To distinguish "melting" caused by decomposition from thermodynamic melting, the researchers have coined a new name – "apparent melting." Schmidt and her colleagues have shown that glucose and fructose are also apparent melting materials.

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    Twitter of the Day

@DrKKAggarwal: #IJCP Dr KK Answers What are the five types of drug fevers? Hypersensitivity reactions Altered… fb.me/yP9eHXsQ

@DeepakChopra: #vmdhealthblog Oral health and its connection to systemic diseases explained in my Health Tip. bitly.com/Dpk_Oral

    Dr KK Answers

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

In chickenpox who needs anti viral drugs?

An antiviral is most beneficial if begun during the first 24 hours of the skin rash. Healthy children with no severe symptoms don’t need an antiviral medication.

The following needs to be started on antiviral

  1. Adults and teens being at risk of more severe symptoms
  2. Adolescents on regular aspirin
  3. People with skin or lung conditions
  4. People on steroids
  5. People who have been exposed to chickenpox, but haven’t contracted the infection, may benefit from an antiviral.

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    Spiritual Update

The Spiritual significance of Indian Flag – Tiranga

Lage Rahon Anna Bhai: The science behind 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. Till about few months back, Anna 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.

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    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

A real story …A chat between a Solider and Software Engineer in Shatabdi Train

An interesting and a must read!

Vivek Pradhan was not a happy man. Even the plush comfort of the air–conditioned compartment of the Shatabdi express could not cool his frayed nerves. He was the Project Manager and still not entitled to air travel. It was not the prestige he sought, he had tried to reason with the admin person, it was the savings in time. As PM, he had so many things to do!! He opened his case and took out the laptop, determined to put the time to some good use. "Are you from the software industry sir," the man beside him was staring appreciatively at the laptop. Vivek glanced briefly and mumbled in affirmation, handling the laptop now with exaggerated care and importance as if it were an expensive car. "You people have brought so much advancement to the country, Sir. Today everything is getting computerized."

"Thanks," smiled Vivek, turning around to give the man a look. He always found it difficult to resist appreciation. The man was young and stockily built like a sportsman. He looked simple and strangely out of place in that little lap of luxury like a small town boy in a prep school. He probably was a railway sportsman making the most of his free traveling pass.

"You people always amaze me," the man continued, "You sit in an office and write something on a computer and it does so many big things outside."

Vivek smiled deprecatingly. Naiveness demanded reasoning not anger. "It is not as simple as that my friend. It is not just a question of writing a few lines. There is a lot of process that goes behind it." For a moment, he was tempted to explain the entire Software Development Lifecycle but restrained himself to a single statement. "It is complex, very complex."

"It has to be. No wonder you people are so highly paid!," came the reply.

This was not turning out as Vivek had thought. A hint of belligerence crept into his so far affable, persuasive tone. "Everyone just sees the money. No one sees the amount of hard work we have to put in. Indians have such a narrow concept of hardwork. Just because we sit in an air–conditioned office, does not mean our brows do not sweat. You exercise the muscle; we exercise the mind and believe me that is no less taxing."

He could see, he had the man where he wanted, and it was time to drive home the point. "Let me give you an example. Take this train. The entire railway reservation system is computerized. You can book a train ticket between any two stations from any of the hundreds of computerized booking centres across the country. Thousands of transactions accessing a single database, at a time concurrently; data integrity, locking, data security. Do you understand the complexity in designing and coding such a system?"

The man was awestuck; quite like a child at a planetarium. This was something big and beyond his imagination. "You design and code such things."

"I used to," Vivek paused for effect, "but now I am the Project Manager." "Oh!" sighed the man, as if the storm had passed over, "so your life is easy now."

This was like the last straw for Vivek. He retorted, "Oh come on, does life ever get easy as you go up the ladder. Responsibility only brings more work. Design and coding. That is the easier part. Now I do not do it, but I am responsible for it and believe me, that is far more stressful! My job is to get the work done in time and with the highest quality. To tell you about the pressures, there is the customer at one end, always changing his requirements, the user at the other, wanting something else, and your boss, always expecting you to have finished it yesterday."

Vivek paused in his diatribe, his belligerence fading with self–realisation. What he had said, was not merely the outburst of a wronged man, it was the truth. And one need not get angry while defending the truth. "My friend," he concluded triumphantly, "you don’t know what it is to be in the Line of Fire".

The man sat back in his chair, his eyes closed as if in realization. When he spoke after sometime, it was with a calm certainty that surprised Vivek. "I know sir,……… I know what it is to be in the Line of Fire………" He was staring blankly, as if no passenger, no train existed, just a vast expanse of time. "There were 30 of us when we were ordered to capture Point 4875 in the cover of the night. The enemy was firing from the top. There was no knowing where the next bullet was going to come from and for whom. In the morning when we finally hoisted the tricolour at the top only 4 of us were alive."

"You are a…?"

"I am Subedar Sushant from the 13 J&K Rifles on duty at Peak 4875 in Kargil. They tell me I have completed my term and can opt for a soft assignment. But, tell me sir, can one give up duty just because it makes life easier. On the dawn of that capture, one of my colleagues lay injured in the snow, open to enemy fire while we were hiding behind a bunker. It was my job to go and fetch that soldier to safety. But my Captain Batra Sahib refused me permission and went ahead himself. He said that the first pledge he had taken as a Gentleman Cadet was to put the safety and welfare of the nation foremost followed by the safety and welfare of the men he commanded… …his own personal safety came last, always and every time. He was killed as he shielded and brought that injured soldier into the bunker. Every morning thereafter, as we stood guard, I could see him taking all those bullets, which were actually meant for me. I know sir…I know, what it is to be in the Line of Fire."

Vivek looked at him in disbelief not sure of how to respond. Abruptly, he switched off the laptop. It seemed trivial, even insulting to edit a Word document in the presence of a man for whom valour and duty was a daily part of life; valour and sense of duty which he had so far attributed only to epical heroes.

The train slowed down as it pulled into the station, and Subedar Sushant picked up his bags to alight. "It was nice meeting you sir." Vivek fumbled with the handshake.

This hand… had climbed mountains, pressed the trigger, and hoisted the tricolour.

Suddenly, as if by impulse, he stood up at attention and his right hand went up in an impromptu salute. it was the least he felt he could do for the country.

PS: The incident he narrated during the capture of Peak 4875 is a true–life incident during the Kargil war. Capt. Batra sacrificed his life while trying to save one of the men he commanded, as victory was within sight. For this and various other acts of bravery, he was awarded the Param Vir Chakra, the nation’s highest military award.

Live humbly, there are great people around us, let us learn!
Life isn’t about how to survive the storm, but how to dance in the rain!!!

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    Gastro Update

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

Complimentary feeding practices between 6 and 24 months

Supporting advice for caregivers and families

  • Make sure children’s immunization schedules are complete by 1 year of age.
  • Use ORT to rehydrate children during diarrhea.
  • Give liquid iron supplements daily (12.5 mg/day) to infants 6 months to one year of age if daily vitamin–mineral supplements or iron–fortified foods are not being given. If the prevalence of anemia is known to be very high (≥40 %), continue supplementation until 24 months of age. For low birthweight infants, start supplementation at 2 months.
  • Give semi–annual, high–dose vitamin A supplements after 6 months (100,000 IU for infants and 200,000 IU for children 12 months and older) in areas where vitamin A deficiency occurs.


  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/UNICEF, 1998.
  2. Dewey KG. Guiding principles for complementary feeding of the breastfed child. PAHO/WHO, 2003.
  3. WHO. Complementary feeding: family foods for breastfed children. Geneva: World Health Organization, 2000.

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Total Iron binding capacity (TIBC)

  • Increased: Acute and chronic blood loss, iron deficiency anemia, hepatitis, oral contraceptives.
  • Decreased: Anemia of infection and chronic diseases, cirrhosis, nephrosis, hemochromatosis

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with normal LDL and high CRP wanted to know his risk of CAD.
Dr Bad: You are not at risk.
Dr Good: Get cardiac 64 CT test done.
Lesson: Among asymptomatic individuals with normal LDL cholesterol levels and elevated high–sensitivity C–reactive protein measuring the burden of calcium in the coronary arteries with cardiac CT appears to stratify the risk of cardiovascular disease (Ref: Blaha M, et al. Associations between C–reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population–based cohort study. Lancet 2011;378:684–92).

For comments and archives

Make Sure

Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

For comments and archives

  Quote of the Day

(Dr Chandresh Jardosh)

Temper is a weapon that we hold by the blade. James Matthew Barrie


(Ms Ritu Sinha)

Dog Days of Summer: The hottest days of the summer season.

  G P Pearls

(Dr Pawan Gupta)

HIV and DM should be ruled out in all patients with TB.

    Medicolegal Update

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

Reconstitution of the body following an autopsy

An important component of the autopsy is the reconstitution of the body such that it can be viewed as normal following the autopsy procedure.

  • After the conduction of postmortem examination, the body has an open and empty chest cavity with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck. All organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation.
  • Normally the internal body cavity is lined with cotton wool or an appropriate material; the organs are then placed into a plastic bag to prevent leakage and returned to the body cavity. The chest flaps are then closed and sewn back together and the skull cap is sewed back in place.
  • The cases of mutilation/dismembered corpse must be surgically repaired into a normal anatomical position.
  • Then the body must be properly sutured and reconstructed by the doctor conducting the autopsy with a cosmetic and parlor touch and then only it should be handed over to the relative of deceased as a regard of human corpse for ritual cremation

For comments and archives

    Mind Teaser

Read this…………………

The most common cause of renal scarring in a 3 year old child is:

1 Trauma.
2 Tuberculosis.
3 Vesicoureteral reflux induced pyelonephritis.
4 Interstitial nephritis.

Yesterday’s Mind Teaser: The HIV type most commonly associated with cancers of the head and neck are:

a. 6,11
c. 30,35
d. 54,55

Answer for Yesterday’s Mind Teaser: b.16,18

Correct answers received from: Dr YJ Vasavada, Dr Chandresh Jardosh, Dr Pramod M Kulkarni,
Dr Subash Vedantam, Dr Dilip Kumar Jha, Dr Anupam, Dr Shashank, Dr Santosh.

Answer for21st August Mind Teaser: 1. Proximal convoluted tubule.
Correct answers received from: Dr Sikha, Dr PArul, Dr Rajiv, Dr Bharat, Dr Sanat, Dr Sudhanshu,
Dr Snehil, Dr Priya.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr.Chandresh Jardosh)

Funny definitions

Ramu writing his medical entrance exam, gives definitions as follows:

  • Antibody: Against everybody
  • Artery: Study of fine paintings
  • Genes: Blue denims
  • Labour pain: Hurt at work
  • Microbes: Small dressing gowns
  • Cardiology: Advanced study of playing cards
  • Cat scan: Searching for lost cat
  • Coma: Punctuation mark
  • Bacteria: Back door to a cafeteria
    Drug Update

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

Drug Name
DCI Approval Date
Spironolactone IP 25mg + Furosemide IP 40mg Tablet
Additional strength
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Acetone in the urine means fat is used as a source of energy

Anna Hazare’s urine shown presence of acetone which means that his fat is now becoming the source of energy, said Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health mela. As long as fat content in the body remains more than 10% the body can tolerate fasting. Anna being 70 kg can afford to lose 10 kg weight.

The fall of upper BP by 30 and rise of pulse by 10 means dehydration and need for more fluids.

  1. Ketonuria is a medical condition in which ketone bodies are present in the urine. Medically it is presence of acetone in the urine.
  2. It is seen in conditions in which the body produces excess ketones as an alternative source of energy. It is seen during starvation or in diabetes. Higher levels of ketones in the urine indicate that the body is using fat as the major source of energy.
  3. Production of ketone bodies is a normal response to a shortage of glucose, meant to provide an alternate source of fuel from fatty acids.
  4. In prolonged fasting insulin deficiency increases fat lysis and increased free fatty acid delivery to the liver. Glucagon excess promotes conversion of free fatty acids into ketoacids in the liver.
  5. Ketone bodies that appear in the urine when fats are burned for energy are acetoacetate and beta-hydroxybutyric acid. Acetone is also produced. Normally, the urine should not contain a noticeable concentration of ketones to give a positive reading.
  6. The body continues to use fat for as long as there is fat to consume. The body will generally indicate to the faster when fat levels are running extremely low (less than 7% and 10% of body weight for males and females, respectively) with an increased urge for food. Fasts are usually broken long before this point. If the fast is not broken, starvation begins to occur, as the body begins to use protein for fuel. Health complications associated with fast–induced starvation include electrolyte imbalances, thinning hair, lanugo, cardiac arrhythmia and renal failure. Death can occur if fasting is pursued to the point of complete starvation.
  7. While fasting one should not take paracetamol as it can case fatal liver damage.
  8. Acetone can be tested by a dipstick or by a lab. The results are reported as small, moderate, or large amounts of acetone. A small amount of acetone is a value under 20 mg/dl; a moderate amount is a value of 30–40 mg/dl, and a finding of 80 mg/dl or greater is reported as a large amount. In prolonged fasting the Ketoacid levels do not exceed 10meq/L and plasma bicarbonate concentration is typically above 14meq/L. The limitation in the degree of ketone formation with fasting in part reflects the ability of ketonemia to promote insulin secretion, thereby limiting the availability of free fatty acids. There is also increased ketoacid uptake by the brain as it switches from glucose to ketones as a source of fuel.
  9. Fasting ketoacidosis is treated by administration of dextrose and saline solutions. The dextrose will increase insulin and reduce glucagon secretion, while the saline will repair any fluid deficit.
  10. The plasma phosphate concentration may fall to low levels with therapy as insulin drives phosphate into the cells. When present, severe hypophosphatemia may be associated with marked and possibly life–threatening complications in these patients, including heart attack.

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    Readers Responses
  1. Dear Sir, Krishna Janmashtami the message from Lord Krishna…was very informative. Regards Dr Anupam
    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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