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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 …

26th April 2012, Thursday

How much water should one drink in summer?

Most agree it is an average of eight cups (consisting of eight fluid ounces) per day. However, the true amount of water intake depends upon several factors, including gender, age, level of activity and environment.

The adequate water intake is 30 ml per kg body weight in a person with normally functioning kidneys and heart.

As an individual grows older, the need for water intake decreases slightly, but adequate water intake is still just as vital to the body’s functioning. In the presence of kidney diseases, excessive water intake does not help prevent kidney disease. In fact, the doctor may recommend restriction of water intake.

Sodium and intravascular volume balance are usually maintained via homeostatic mechanisms until the kidney functions fall below 10 to 15 mL/min. However, the patient with mild to moderate chronic kidney disease, despite being in relative volume balance, is less able to respond to rapid infusions of sodium and is therefore prone to fluid overload. In summer, such patients should therefore take extra salty water only after medical consultations.

On the contrary, hypovolemia (such as vomiting, diarrhea, diuretic use) may cause potentially reversible declines in renal function. These patients need excess of fluids to replenish the amount lost in vomiting or diarrhea.

Your level of activity is one of the greatest indicators of the amount of water you should drink each day. As you exercise, your body will begin to excrete more water through perspiration and require more water for proper replenishment. For a short bout of exercise (less than 30 minutes), one to two extra glasses will replenish the body. If you are exercising for longer periods of time or in warmer climates, you will likely need to drink at least three extra glasses of water per day to replace any liquid lost during the process.

Your environment also affects the amount of water you should drink. Individuals in warmer climates should drink more water to compensate for liquid lost through perspiration. Individuals who live at high altitudes may also need to drink more water, as the lack of oxygen in the air prompts more rapid breathing and a greater loss of moisture during respiration.

Everyone, regardless of their environment, should drink more water during the summer months, as the heat and extra time spent outside can result in greater liquid loss.

Rules of thumb

  1. Arm pit test: the arm pit should always be wet, if dry indicated significant dehydration.
  2. Urine output measure: one must pass urine once in eight hours. If not consult your doctor.
  3. Know your kidney function: 14 – minus age in years multiplied by weight in Kg and divided by 74 into serum creatinine levels. If the number is less than 100, talk to your doctor for the salt and water intake amount. In females, 85% of this number should be taken into account.
  4. All patients with heart and liver disorders should talk to their doctor about the fluid and salt intake measures.

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

Weight Loss may improve Sexual Health of Obese Diabetics

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

How to be Happy and Healthy

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India interacting with the audience during the seminar on How to be happy and healthy.

Dr K K Aggarwal
    National News

Less than 1% Indians know cardiopulmonary resuscitation

NEW DELHI: Indians are far behind in the global surge to learn cardiopulmonary resuscitation (CPR) – a combination of rescue breathing and chest compressions delivered to victims of cardiac arrest. While several countries across the world are training the common man – in schools, colleges and even work places –– about chest compressions or CPR to save sudden cardiac victims from dying, the World Heart Federation (WHF) says less than 1% Indians would presently know how to carry out a CPR. The revelation is stark since 7.5 lakh people die of sudden cardiac arrests every year in India with over 80% of these emergencies occurring outside a hospital setting. On average, a victim begins to suffer irreversible brain damage four minutes after the cardiac arrest takes place and if no CPR is administered. For every minute that a cardiac arrest victim does not receive CPR, his chances of survival drops by 10%. An effective CPR from a bystander can double a victim’s chances of surviving a cardiac arrest. Speaking to TOI, Dr K Srinath Reddy, the new president of the World Heart Federation, said, "Less than 1% Indians would know how to carry out a CPR. What’s worse, even medical students in India aren’t adequately trained in the correct technique of performing CPR. Most of them learn on the ground during internship if they have to revive a cardiac arrest patient." (Source: TOI, Apr 23, 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

TIPS 2: Full–dose polypill boosts efficacy, with no increased side effects

A full–dose polypill strategy, combining aspirin, three antihypertensives, and a statin, not surprisingly produced greater drops in blood pressure and LDL cholesterol than those seen in the original half–dose combination pill, but with no significant differences in adverse effects, results of the TIPS 2 trial show. (Source: Medscape)

For comments and archives

AIM–HIGH fell short, leaving experts looking for reasons in new review

When the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM–HIGH) study was stopped early for futility, researchers and clinicians alike were disappointed and somewhat perplexed. The confusion stemmed from past studies with niacin, an agent used frequently in clinical practice to raise HDL–cholesterol levels, showing the drug provided a benefit in cardiovascular risk protection. In addition, observational studies have clearly shown that low levels of HDL cholesterol are associated with an increased risk of cardiovascular disease. (Source: Medscape)

For comments and archives

XAMOS: Rivaroxaban in real–world orthopedic prophylaxis

The new oral anticoagulant rivaroxaban (Xarelto, Bayer) has shown positive results in the XAMOS real–world trial in patients undergoing orthopedic surgery. The trial was presented here earlier this week at the British Society of Hematology 2012 Scientific Meeting by chair of the XAMOS executive steering committee, Dr Alexander Turpie (McMaster University, Hamilton, ON). (Source: Medscape)

For comments and archives

Statin therapy prior to CABG reduces the risk of postoperative AF

Statins administered prior to cardiac surgery significantly reduced the risk of postoperative atrial fibrillation and resulted in a significantly shortened length of stay in the intensive care unit (ICU), according to the results of a new meta–analysis. Preoperative statin therapy had no effect on short–term mortality and postoperative stroke rates, however. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: First Cigarette Of The Day Most Harmful

@DeepakChopra: If you allow your consciousness to do what it naturally wants to do, the most creative way to meet any challenge will unfold itself.

    Spiritual Update

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

Meaningful Coincidences: Synchronicity

If you meet someone you haven’t met for a long time, stop and talk to him or her. Remain aware of a message from the Universe that they might be carrying for you. Follow the coincidence through, and you’ll be amazed to find where it takes you.

Time and again, we all experience coincidences that have some special meaning or significance, and that appear to defy the laws of probability. Most of us tend to ignore them as something amusing or insignificant.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What about miscarriage in the IVF procedure?

According to western figures, the rate of miscarriage may be as low as 15% for women in their 20s to more than 50% for women in their 40s. There is a 2–4% risk of an ectopic, or tubal, pregnancy if an embryo moves from the uterus into the fallopian tube. If an ectopic pregnancy occurs, you will need medication to end the pregnancy or surgery to remove it. If you are pregnant and experience a sharp, stabbing pain, vaginal spotting or bleeding, dizziness or fainting, low back pain or low blood pressure (from blood loss), call your doctor immediately. These are all signs of a possible ectopic pregnancy.

For comments and archives

    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)

How is the tissue harvested from a donor?

Tissue is retrieved either through enucleation (whole eye ball removal) or corneal excision. Presently many eye banks in the country retrieve cornea by in situ corneal excision. This procedure involves removing just the cornea from the whole eye of the deceased/donor. During corneal excision, the cornea along with the white part of the eye known as the sclera is excised out. A 2–3mm scleral rim is excised 360 degrees. The procedure takes 20 to 30 minutes. The excised cornea is introduced into a preservative medium, the Mc Carey Kaufman medium (MK medium), which is prepared by the Rotary Club of Hyderabad, Cornea Preservation Center and distributed to all eye banks in the country and South East Asian countries. The MK medium allows preservation of the cornea for a period of 4 days.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The seed

Once upon a time, there was a seed and because it was only a seed, nobody cared to notice it. Thus, gripped by a sense of inferiority, the seed gave no importance to his existence.

Then one day, a wind picked him up – randomly or otherwise he didn’t know – and threw him mercilessly on an open field under the sweltering sun. He was confused. Why would anything do such a thing? But instead of any copasetic answers, he was provided with rain (in addition to sunlight); sometimes in drizzles and sometimes in torrents.

Meanwhile time flew and years later he saw a traveler sitting by his side. "Thank you God for this. I really needed some rest," he heard the traveler say.

"What are you talking about?" The seed promptly asked. He thought the man was making fun of him. Sure, he had witnessed many people sitting by his side – more so in recent years – but no one ever spoke to him like that.

"Who is this?" The man was startled. "This is me. The seed." "The seed?" The man looked at the giant tree. "Are you kidding me? You are no seed. You are a tree. A goliath of a tree!" "Really?" "Yes! Why else do you think people come here?" "What do they come here for anyways?" "To feel your shade! Don't tell me you didn’t know you had grown over time."

A moment passed before the traveler’s words struck the chord of realization within him. The seed, now a prolix tree, thought and smiled for the first time in his life. The years of relentless tortures by the sun and the rain finally made sense to him.

"Oh! That means I'm not a tiny–flimsy seed anymore! I wasn’t destined to die unnoticed but was actually born to strip people of their lassitude. Wow! Now that’s a life worth a thousand gems!"

For comments and archives

    Cardiology eMedinewS

Low–fat dairy skims off stroke risk Read More

Meta–analysis shows link between GI symptoms and rising BMI
Read More

    Pediatric eMedinewS

Think carrots, not candy as school snack: advocates Read More

Pediatric ICUs may not be used to potential Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 30–year–old male with suspected migraine came with runny nose.
Dr. Bad: It cannot be migraine.
Dr. Good: It can be migraine.
Lesson: Migraine can also cause nasal stuffiness and runny nose, or teary eyes in 10–20% of individuals.

For comments and archives

Make Sure

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?
Lesson: Make sure all patients with rheumatoid arthritis are started with specific treatments within 3 months of diagnosis.

For comments and archives

    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. An electric cable company worker accidentally received electric shock while on duty, fell from electric pole and became quadriplegic. He was treated by doctors and an MRI was done. He has filed a civil suit against the company for compensation and has also impleaded the hospital, the doctors and the MRI facility as respondents and has alleged that all of them should have made an MLC but did not do so. My questions are:

a. Does any responsibility lie on the MRI facility to make an MLC?

b. The MRI facility is owned by the medical college. Who should represent the MRI facility–– The Radiologist/The CMO/The Medical Superintendent?

c. Who is to bear the legal expenses?


  1. No responsibility lies on the MRI facility to make an MLC.
  2. The MRI facility should be represented by its owner.
  3. Legal expenses have to be borne by the parties concerned.

For comments and archives

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    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Transmission of blood–borne infections amongst HCWs following exposure to infected blood and other potentially infected materials (OPIMS)

We have already discussed in our earlier columns that the HCWs, particularly those working in disciplines where contact with blood and body fluids is frequent and who perform high risk procedures are at higher risk of accidental exposure to blood and body fluids through accidental injury (cut, needle stick, scratch, splash in the eye, etc.)

The rates reported for documented infections following needle stick/percutaneous exposure/cuts from other sharps with blood/body fluids and OPIM are:

  • HIV: 0.2–0.4% (WHO–0.332%)
  • HBV: 6–30%
  • HCV: 2–3% (up to 9%)

Risk of HBV transmission is maximum due to higher viral load of this virus in the blood and bloody fluids (1013 HBV particles/ml of blood compared to 104 HIV particles/ml of blood). CDC distinguishes between "documented" and "possible" occupational transmission of HIV. "Documented" infection refers to documented seroconversion in HCW after occupational exposure. "Possible" infection refers to history of occupational exposure to infected blood or OPIM in healthcare workers without identifiable behavioral or transfusion risks, but for whom seroconversion specifically resulting from an occupational exposure was not documented, i.e., a baseline, test following exposure for HIV was not performed.

  Quote of the Day

(Dr Anil Kumar Jain)

When GOD solves your problems, you have faith in HIS abilities; when GOD doesn’t solve your problems HE has faith in your abilities.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Mean Corpuscular Hemoglobin Concentration

MCHC (g/dL) = Hemoglobin (in g/dL)/HCT (in %) × 100

Reference values are 32–34 g/dL

Interpretation: Low MCHC suggests iron deficiency anemia; high MCHC suggests spherocytosis, dehydration, sickle cell anemia or unstable hemoglobin

    Mind Teaser

(Dr Anil Kumar Jain)

Read this…………………

What was King George VI’s first name?

Yesterday’s Mind Teaser: How long did the Hundred Years War last?

Answer for Yesterday’s Mind Teaser: 116 years

Correct answers received from: Dr KV Sarma, Rajiv Kohli, Dr Avtar Krishan, Yogindra Vasavada, Dr PC Das, Dr Thakor Hitendrsinh G, Dr Neha (Singh) Shrivastava, Sudipto Samaddar, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr U Gaur.

Answer for 24th April Mind Teaser: November

Correct answers received from:
Ritu Sinha

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Law of Cat Embarrassment

A cat’s irritation rises in direct proportion to her embarrassment times the amount of human laughter.

    Medicolegal Update

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

What is the right to refuse medical interventions?

Theresa Marie "Terri" Schiavo case of the United States

The consistent refusal to intervene on behalf of Schiavo’s parents’ desire to continue nutrition and hydration is a reaffirmation of the right to refuse medical care even for mentally incapacitated patients and that artificial nutrition and hydration are medical treatments. In theory, the right of patients to refuse medical therapy can be limited by four state interests in: Preservation of life, Prevention of suicide, Protection of third parties such as children and Preserving the integrity of the medical profession. In practice, these interests almost never override the right of competent patients and incompetent terminally ill patients who have left explicit advance directives.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Negative stress is an important cause of heart attack and lifestyle disorder

Negative stress is an important cause of heart attacks and lifestyle disorders, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal who is also President of Heart Care Foundation of India.

Relational disharmony and job dissatisfaction are the two main factors responsible for development of heart and brain blockages leading to heart attack and paralysis.

Dr. Aggarwal said that stress is nothing but a reaction of mind and the body to the interpretation of a situation. To reduce stress one needs to either change the situation, change the interpretation or prepare the body through yoga in such a way the stress does not bother a person. If not controlled, stress can lead to acute rise in pulse rate and blood pressure.

He said that stress should not be suppressed or expressed. Giving an example, he said that if anger is expressed it can lead to rupture of heart blockages leading to heart attack and if suppressed it can lead to formation of blockages leading to future heart attack. The answer is managing the stress by acting on it and not reacting on it.

Heart attack cannot be accepted or given as a gift. One has to work against the laws of nature for over a decade to get the process of heart attack initiated. Prevention is the best answer.

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    Forthcoming Events
Dr K K Aggarwal

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

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