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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 …

25th August 2011, Thursday

Barrett’s esophagus and high–grade dysplasia management

For most patients with Barrett’s esophagus and high–grade dysplasia who are fit to undergo endoscopy one should opt for endoscopic eradication therapy rather than esophagectomy or intensive endoscopic surveillance. Guidelines issued by the American Gastroenterological Association in 2011 now suggest endoscopic eradication therapy as the preferred approach for patients with Barrett’s esophagus and high–grade dysplasia.

To tackle increased risk for esophageal adenocarcinoma, up till now neoplastic epithelium was removed by esophagectomy but the procedure carried significant procedure–related mortality and long–term morbidity.

The current recommendation is endoscopic eradication therapy, which includes endoscopic mucosal resection followed by radiofrequency ablation.

(Ref: American Gastroenterological Association. American Gastroenterological Association Medical Position Statement on the Management of Barrett’s Esophagus. Gastroenterology 2011;140:1084).

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  eMedinewS Audio PostCard

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

on Science of Festival

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issue

Dr Girish Tyagi presented his views on ‘What is medical negligence’? in the recently concluded National Conference on Insight on Medico Legal Issue

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


Cancer, diabetes, hypertension largest cause of death

Lifestyle–related diseases are now killing more Indians than the infectious ones. India’s disease pattern has undergone a major shift over the past decade, says the World Health Organisation (WHO). The latest WHO data paints a worrying picture. At present, out of every 10 deaths in India, eight are caused by non–communicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes in urban India. In rural India, six out of every 10 deaths is caused by NCDs. Similar is the trend in the Southeast Asian region. While NCD deaths have seen a 21% jump, infectious diseases deaths have fallen by 17%. The projection is that the South–east Asian region will have the greatest total number of NCD deaths in 2020: 10.4 million. Speaking to TOI, Dr Nata Menabde, WHO representative to India, said: "Globally, 60% of the deaths are now caused by NCDs. Similar are the numbers in India. NCDs are affecting the entire globe. If not controlled, they will become a tsunami that will not only kill people but impair development and crash economies." (Source: TOI, Aug 24, 2011)

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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)

New target against type 2 diabetes and prediabetes identified

Researchers at the Joslin Diabetes Center have identified a new drug target for treatment of type 2 diabetes and prediabetes. In their study, they have shown that an enzyme, Sirt3, found in the mitochondria – the power producers of cells that convert energy into usable forms – of cells is decreased in the skeletal muscle of those with diabetes, a finding that could lead to the development of drugs to boost the activity of this enzyme in an effort to fight the disease. "Ours is perhaps the first study to understand what is going wrong in the mitochondria of those with diabetes," said senior author C. Ronald Kahn, M.D., Head of the Joslin Section on Integrative Physiology and Metabolism and the Mary K. Iacocca Professor of Medicine at Harvard Medical School. The goal for the future will be to find ways to restore levels of Sirt3 or increase the activity of the existing Sirt3, perhaps with a drug, in a bid to improve insulin resistance in the muscle and improve muscle metabolism, he said. "It is a new target," he said. "Agents which increase Sirt3 activity could, therefore, potentially reverse at least some of the adverse effects of type 2 diabetes," the paper concludes. The study was recently published in the Proceedings of the National Academy of Sciences. (Source: New target against type 2 diabetes and prediabetes identified, Aug 23, 2011)

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Biscuits, cakes up ‘womb cancer’ risk

Women beware. Eating biscuits, buns or cakes three times a week could give you womb cancer, says a new study. The 10–year study from the Karolinska Institute in Sweden looked at the eating habits of more than 60,000 women and found that those who gave themselves such a treat regularly were 33 per cent more likely to suffer the disease. And for those who indulge more than three times a week, the risk jumps to 42 per cent, reports the Daily Mail. (Source: TOI, Aug 23, 2011)

For comments and archives

HPV test best for detecting for cervical cancer

A DNA test for cancer–causing human papillomavirus (HPV) catches risky cervical lesions better than liquid–based cytology, researchers found. Detection of the most dangerous HPV–16 and HPV–18 types predicted high–grade cervical intraepithelial neoplasia with 92% sensitivity compared with cytology’s 53.3% (P<0.0001), Philip E. Castle, PhD, of the American Society of Clinical Pathology Institute in Washington, D.C., and colleagues reported. (Source: Medpage Today)

For comments and archives

    Fitness Update

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

Resistance training helps smokers quit

New research shows that lifting weights could be the key to helping smokers quit. According to a study conducted at Brown University and published online by the journal Nicotine & Tobacco Research, male and female smokers who completed a weight training program in conjunction with smoking cessation treatment were twice as likely to kick the habit. A group of 25 smokers undergoing a smoking cessation program were divided into two groups: one performed a strength routine regularly, and one did not. The resistance training group performed two 60–minute training sessions per week for 12 weeks. The program was a full–body routine involving ten different exercises, with gradually increasing weight and intensity every three weeks. By the end of the 12 weeks, 16 percent of weight–lifting smokers had not only decreased their body weight and body fat, but they also quit smoking. In comparison, only eight percent of people in the group who were not lifting weights had quit smoking.

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    Twitter of the Day

@DrKKAggarwal: #AJOG Women who abandon HRT skip screening Mammo too Some women under age 64 who ditched hormone replacement… t.co/Cp3oFqy

@DeepakChopra: #CosmicConsciousness Humility, awe, wonder and reverence for the mystery of the unknowable deepen and enrich our experience of God

    Dr KK Answers

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

What are the methods of treating heart blockages?

The methods of treatment can be understood by "Dr KK’s formula of easing out traffic congestion". In any traffic one uses green and red lights to discipline the traffic; post a traffic inspector to divert the traffic; hire an architect to see the status of the roads; o widening of the arteries and build fly over or underpasses with or without stopping the traffic.

In terms of heart blockages green and red light indicates correcting and to discipline the life style. Red light indicate don’ts in life and green light indicates do’s in life.

Hiring of a traffic inspector indicates hiring a cardiologist to prescribe drugs to reduce the demand and increase the blood supply and divert the flow to smaller channels through drugs.

Hiring the architect means denotes consulting an interventional cardiologist to do angiography to know the extent of blockages and the alternative repair procedures available.

Widening of the roads means opening the blocked arteries with balloon angioplasty. To prevent re encroachment of the roads railings are put on the roads. In terms of heart blockades it is equivalent to open the artery with balloon and put a metallic stent.

When a stent is put it can be bare metal stent or a drug eluting stent. Drugs are eluted on a metallic stent to prevent formation of a clot over them. Now a days instead of using drug eluting stents some cardiologists are eluting the baloons with the drugs so that either they can avoid a stent altogether or put a bare metal stent after that to reduce the cost.

Finally if stent cannot be put in, building flyover is equated to doing a bypass surgery.

For comments and archives

    Spiritual Update

Why don’t we eat curd in the months of Bhadon?

It is a traditional Ayurveda saying that one should not take green leafy vegetables in the month of Shravan, curd (yogurt, dahi) in the month of Bhadon, milk in the month of Ashwin and butter milk (mahi, matha), pulses and oil in the month of Kartik

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Be Positive

Father: "I want you to marry a girl of my choice."

Son: "I will choose my own bride!"

Father: "But the girl is Bill Gate’s daughter."

Son: "Well, in that case… ok"

Next Father approaches Bill Gates.

Father: "I have a husband for your daughter."

Bill Gates: "But my daughter is too young to marry!"

Father: "But this young man is vice–president of the World Bank."

Bill Gates: "Ah, in that case… ok"

Finally Father goes to see the president of the World Bank.

Father: "I have a young man to be recommended as your vice–president."

President: "But I already have more vice–presidents than I need!"

Father: "But this young man is Bill Gate’s son–in–law."

President: "Ah, in that case… ok"

This is how business is done!!

Moral: Even if you have nothing, you can get anything. But your attitude should be positive.

For comments and archives

    Gastro Update

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

What are the features of physical examination of chronic liver disease in children?

  • Firm to hard hepatomegaly
  • Moderate to massive splenomegaly
  • Growth failure
  • Significant ascites, pedal edema, prominent abdominal veins, clubbing, muscles wasting, CLD signs

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Increased: Hypernatremia, hyperglycemia, water loss (diuretics, diabetes..), alcohol ingestion, ethylene glycol ingestion, mannitol.

Decreased: Hyponatremia, diuretics, Addison’s disease, SIADH.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient in insulin pump was taking a flight.
Dr Bad: Its ok to use the pump.
Dr Good: Disconnect the pump at landing and taking off.
Lesson: According to a study published online Aug. 4 in the journal Diabetes Care, changes in airliner cabin pressurization during take–off and landing may affect how much insulin is delivered by an insulin pump. Pumps should be disconnected during take–off and landing and during any flight situations in which a loss of cabin pressure results.

For comments and archives

Make Sure

Situation: A 28–year–old male presents with increased frequency and occasional blood in urine. Urine examination shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. A sterile pyuria is the first clue to diagnosis.

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(Dr Chandresh Jardosh)

Never hate those people who are jealous of you, but respect their jealousy. Because they are the ones, who think that you are better than them.


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(Dr Pawan Gupta)

Mucolytics reduce COPD exacerbations by 29%. (Int J Chron Obstruct Pulmon Dis. 2006 June; 1(2): 123–128).

    Medicolegal Update

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

Doctor is neither a detective nor a curtain between patient and police

  • Presumption, assumption hypothesis, and mere conclusion on self–defined interpretation is not a proof, and conjecture is not medical evidence which may be used by a doctor for his/her patient
  • The primary and absolutely transparent duty of a doctor/hospital is to provide medical services to sick and injured patient may be an alleged criminal to save his health/limb and life without any discrimination.
  • when the medical care records is required for judicial/police investigation the records becomes medico–legal in nature and the same may be required to testify under oath in the court of law by treating doctor.
  • The doctor should acquire the habit of making a careful note of all the facts observed by him with exact time and date.
  • doctor should examine the facts which come to his knowledge in his special medical man capacity, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and elaborate in the Court that interpretation, along with the medical grounds on which it is based.
  • Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on medical witness for an opinion and expects him to assist it with his special knowledge and experience in perusal of truth.

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    Mind Teaser

Read this…………………

HPV genes with oncogenic potential include:

a. E4.E5
b. E5,E6
c. E6,E7
d. E7,E8

Yesterday’s Mind Teaser: Which of the following is the most troublesome source of bleeding during a radical retro pubic prostatectomy?

1. Dorsal venous complex
2. Inferior vesical pedicle
3. Superior vesical pedicle
4. Seminal vesicular artery

Answer for Yesterday’s Mind Teaser: 1. Dorsal venous complex

Correct answers received from: Dr Madhulika Sharma, Dr Chandresh Jardosh, Dr Anil Kumar Jain,
Dr Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay.

Answer for 23rd August Mind Teaser
: 3. Vesicoureteral reflux induced pyelonephritis.
Correct answers received from: Dr Sukanta Sen, Dr Dinesh Yadav, Dr G Padmanabhan, Dr Anil Kumar Jain, Dr Abid Ahmed, Dr Madhavi Tripathi, Dr Rajiv Kohli, Dr Palllipalayam Sivaramakrishnan Ragavan,
Dr Subash Vedantam, Dr yJ Vasavada.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Chandresh Jardosh)

Funny definitions


"When you breathe, you inspire. When you do not breathe, you expire"
"Respiration consists of two acts: first inspiration, then expectoration."

    Drug Update

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

Drug Name
DCI Approval Date
Moxifloxacin HCl BP 0.5% w/v + Bromfenac Sodium 0.09% w/v Eye drop
For the reduction of post operative inflammatory conditions of the eye


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(Press Release for use by the newspapers)

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Do not eat curd in Bhadon month?

One should not take green leafy vegetables in the month of Shravan and curd (yogurt, dahi) in the month of Bhadon said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President heart Care Foundation of India and MTNL Perfect Health Mela.

One should also avoid milk in the month of Ashwin and butter milk (mahi, matha), pulses and oil in the month of Kartik.

Ayurveda defines the concepts of Vata, Pitta and Kapha. In terms of modern medicine, Vata represents movement; Pitta metabolism and Kapha structure and water.

As per Ritucharya (seasonal routine), Vata or movement functions in the body are aggravated in Varsha Ritu (rainy season) which coincides with Shravan and Bhado months. During these months, pitta starts accumulating.

Pitta or metabolism is aggravated in Sharad Ritu (Ashwin and Kartik months) and Kapha in the Vasant Ritu (Chaitra and Vaisakha). In Sharad Ritu when Pitta gets aggravated the Kapha is accumulating.

In the month of Shravan, as Vata or movement function is aggravated, any food item which aggravates Vata or movement will cause harm to the body. Ground leafy vegetables increase Vata, and therefore, are prohibited in the month of Shravan. According to modern medicine, during rainy season, most of the ground worms will also come to the surface and infect the leafy vegetables. This is another reason why leafy vegetables are harmful to the body in the month of Shravan.

In Varsha Ritu (Rainy season), Vata is aggravated but Pita has stated accumulating which gets aggravated in Sharad Ritu. Therefore in the month of Bhadon, it is advised to eat less yogurt (dahi) as anything fermented aggravates Pitta. Though Ayurveda says that curd should not be eaten in the month of Bhadon season, from allopathic point of view, it should be true for all fermented foods including alcohol, dosa, idli or dhokla etc.

Kapha producing substances like milk and butter milk are avoided in Sharad Ritu as at that time Kapha is accumulating and Pitta is aggravated.

As per the Ayurveda in the month of Shravan and Bhadon, the digestive fire is weak and, therefore, any substance which can obstruct the digestive channels should be avoided and curd is one of them.

Ayurveda also prohibits eating curd in the night throughout the year as after 6 pm the digestive fire in the body is weak, Kapha is predominant and any curd food taken at that time will block the digestive channels.

Naturopathy is in agreement with Ayurveda but Allopathy is silent on this issue. Without going into the details of the subject the conclusion is to avoid eating curd in the month of bhadon.

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    Readers Responses
  1. In This World Of e–mail, e–paper, e–recharge, e–transfer, e–commerce Never, Forget E–SHWAR, Who Makes e–verything e–asy For e–veryone e–veryday. Dr Chandresh Jardosh
    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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