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Dr KK Aggarwal

From the Desk of Editor in Chief
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

26th July, 2010, Monday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

                                                    Sawan Ka Mahina Pawan Kare Sor

This was a famous song in the movie Milan which has a lot of health implications. During Sawan, air both in the body as well as in the atmosphere gets vitiated leading to storm of rains, high tides in the ocean and movement related disorders in the body. Ayurveda describes them as VATA disorders and homeopathy describes them as Psora disorders. In allopathy, in terms of physical health, it represents dyspepsia, gases, dystensia, constipation, tachycardia, accelerated hypertension etc. and in terms of mind, it represents instability of mind, irritableness, anger and unsteady mind. This is one reason why in Sawan, auspicious functions are not held, including marriage as a marriage requires lot of cooperation, mental understanding and a steady mind.

The mind is more unstable during Sawan is also depicted by the festival Guru Purnima which also falls in Sawan month. It indicates that during Sawan, one requires supervision to tame the mind.

The Nag panchami also falls around this season. Nag is a symbolic representation of ego and Nag puja indicates again taming the mind and controlling the ego.

Leafy vegetables are not allowed to be eaten during this month as they precipitate Airy disorders. It is also during this month that leafy vegetables contain more worms and their eggs and are unhygienic to ea especially in a community food serving.

Another filmy song Mere Naina Sawan Bhadon Phir Bhi Mera Man Pyasa depicts the unstable state of mind during Sawan.

Sawan is also the month where on every Monday Lord Shiva is worshipped. Lord Shiva represents ability to wind up jobs. The unstable mind in Sawan month does not allow one to take decisive actions. Shiv ki pooja represents that it takes efforts to wind up jobs in Sawan month.

During Sawan month, Lord Vishnu is also seen lying under a Sheshnag in an ocean in an open eye meditative pose. The ocean represents the disturbed state of mind, Sheshnag indicates the need to control the ego and meditative pose of Vishnu represents the need to do pranayama and meditation in this season and also it indicates that it is very easy to get dissociated from your consciousness in this month as the ego gets easily activated during this period.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)

MTNL Perfect Health Mela 2009

A press conference was organised on August 20, 2008 by Heart Care Foundation of India (HCFI) to announce the dates of Perfect Health Mela (PHM) and release the posters for various events that will be part of the PHM 2008

In This Photo: Padma Shri and Dr. B C Roy National Awardee Dr K K Aggarwal doing a check-up of Famous Hasya Kavi Surender Sharma during a press conference.

Dr k k Aggarwal


News and views


Vital statistics to know and keep

1. Crude birth rate is number of live births per 1,000 population. Crude death rate is number of deaths per 1,000 population. Natural growht rate = Subtract deaths from births. Infant mortality rate is number of babies up to one year of age dying per 1,000 live births.

2. CBR has  dipped from 26.4 to 22.8 for India from 1998 and 2008, a 14% decline.

3. In Punjab, CBR has fallen by 23%; in Kerala and Maharashtra (by 20%) and West Bengal (by 18%).

4. CDR has come down by 18% in a decade.

5. Both Madhya Pradesh and Rajasthan has shown a 23% dip in CDR, Bihar by 22% and UP by 20%.

6. Natural growth rate for India has declined by 11%. In Kerala and Punjab, the rate has slowed down by 32%; in Maharashtra by 23% and in Andhra Pradesh, Tamil Nadu and West Bengal, by 18%.

7. IMR: has declined  in India from 72 in 1998 to 53 in 2008, a decline of 26%.

8. Tamil Nadu has slashed IMR by 42%, West Bengal by 34%, Maharashtra by 33% and Orissa by 30%.

9. Some states have shown increases in IMR [Delhi (-13%), J&K, Mizoram and Meghalaya].

10. Kerala has the lowest birth rate of 15 per thousand, followed by Tamil Nadu (16), Punjab (17) and West Bengal (18). Death rates are lowest in West Bengal (6.2 per thousand) followed by Kerala, Maharashtra, Rajasthan, Gujarat, Haryana, Jharkhand, Punjab and Bihar (all around 7). The natural growth rate was lowest in Kerala (8 per thousand) closely followed by Tamil Nadu (about 9), Punjab (10) and AP as well as West Bengal (both about 11). Infant mortality rate was again lowest in Kerala at 12 per thousand live births. Then came Tamil Nadu (31), Maharashtra (33) and W Bengal (35).

11. Reasons; more institutional deliveries, better sanitation and availability of life-saving drugs, better rural incomes in West Bengal, high education levels in Kerala and better economic standards in Punjab.

a. computed from the annual Sample Registration System (SRS) survey done by the government's Census office for the years 1998 and 2008. The 2008 survey covered a sample of 7.1 million people spread across the country.
b. TOI


Assessing Brain Infarction may Improve ABCD2 System’s Ability To Predict Stroke In TIA Patients

A study published in the journal Stroke reports that by incorporating the presence or absence of brain infarction into the ABCD2 system, the ability of the score to predict stroke in patients with transient ischemic attack (TIA) can be improved.

People Who Feel Anxious about Relationships May Be Predisposed To Certain Health Problems

Individuals anxious about relationships or those who avoid them may be at risk of certain health problems. People who were insecure in their relationships were at a greater risk of health problems including heart disease, and had a 50% higher risk for heart attack or stroke than those individuals who did not have relationship anxiety. The study findings are published in the July issue of the journal Health Psychology

Telephone Intervention may Benefit Patients With Heart Failure

A simple, inexpensive telephone intervention by nurses that emphasized education and monitoring was associated with clinical benefit for heart failure patients, according to a study published in the July 27 Journal of the American College of Cardiology. The telephone intervention aimed to optimized monitoring of symptoms, diet, exercise, weight control and compliance to therapy. The intervention group had fewer hospitalizations due to heart failure and lower death rate vs usual treatment. These benefits of intervention persisted at 1 and 3 years after the intervention ended.

FDA Panel Calls To Revoke Approval Of Avastin To Treat Breast Cancer

According to a panel of government advisers, all of them cancer experts, Avastin (bevacizumab) should no longer be recommended for women with advanced breast cancer.

(Contributed by Dr Monica and Brahma Vasudeva)


Legal Column

Forensic Column: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Summon from court of law (part 3)

A summons must be obeyed by the doctor/hospital, and all documents should be produced, if asked for. The doctor, as witness, may be excused from attending the Court, if he has a valid and urgent reason such as an unavoidable medical/surgical emergency that needs his attention in the imminent interest of patient health, but a communication must be given to the court by doctor or any person authorized on his behalf or hospital management or legal counsel. If the witness fails to attend the Court in a civil case, he will be liable to pay damages. However, in criminal cases, the Court may issue notice under Section 350, Cr. P.C. and after hearing the witness, if it finds that the witness neglected to attend the Court without any justification, may sentence him to a fine, or the Court may issue warrants to secure the presence of the doctor for witness.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Gastroesophageal Reflux Disease in Children (Cont…)

Management of GERD

The management goals are directed towards eliminating symptoms, healing mucosal injury, preventing relapse and managing complications. Management of GERD in children can be divided into

  1. Lifestyle changes
  2. Pharmacological therapies
  3. Surgical management

Question of the Day

What are the aspects of screening and management of the asymptomatic but high–risk postmenopausal woman? (Dr. M Mani, Delhi)

Menopause–related estrogen deficiency increases the risk of CVD. The presence of abdominal obesity, dyslipidemia, HT, fasting hyperglycemia or impaired glucose tolerance further aggravate the CVD risk imposed by menopause. Health check–ups should ensure record of gestational diabetes mellitus, alcohol intake and smoking as well as family history of cardiovascular disease. Screening should include plasma lipid profile, blood glucose, liver, renal, thyroid function test and baseline CRP and homocysteine. Serum LDL–C > 130 mg/dl is associated with an increased risk of CVD. Levels of TG ≤ 150mg/dl and HDL–C ≤50 mg/dl coupled with an increase in small dense LDL and VLDL particles constitute the atherogenic dyslipidemia, which characterizes the metabolic syndrome. Non–pharmacological intervention should be targeted towards smoking cessation, a low salt–low fat high fiber diet and increased physical activity.


Public Forum (Press Release for use by the newspapers)

Excess Weight Speeds Up Osteoarthritis

Apart from heart disease and diabetes, being overweight or obese can cause rapid deterioration of the cartilage in the knee, leading to osteoarthritis. With every one unit increase in body mass index (BMI), the chances of rapid cartilage loss increased 11 percent, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Osteoarthritis is the most common musculoskeletal disorder with major health and socioeconomic impact in our aging society. Osteoarthritis usually progresses slowly, but some patients experience a more rapid progression.

In a report published in the journal of Radiology, researchers recruited 336 patients from a major osteoarthritis study. All were overweight and at risk of osteoarthritis, but had minimal or no loss of cartilage in their knees. During 30 months of followup, 20.2 percent of the patients showed a slow loss of knee cartilage and 5.8 percent had rapid cartilage loss. The main risk factors for cartilage loss were preexisting cartilage damage, being overweight or obese, tears or other injury to the cartilage at the knee joint (meniscus), and severe lesions seen on an MRI. Other factors include inflammation of the membrane lining the joints and abnormal buildup of fluid in the joint.

Weight loss is probably the most important factor to slow disease progression. Danger of developing osteoarthritis is another reason to control weight.

Do not let yourself get heavy. People who are heavy are the ones that are getting worse. Keeping your weight down through diet and exercise or weightloss surgery could prevent the need for kneereplacement surgery


Commonwealth Medical Association (Dr. S. Arulrhaj, MD., FRCP (Glasg), President)

Commonwealth Foundation

Commonwealth Foundation is an intergovernmental organization resourced by and reporting to commonwealth Governments and guided by Commonwealth values and Priorities. Commonwealth Foundation was established by Heads of Government in 1965 and as on date has 46 Governments. http://www.commonwealthfoundation.com


An Inspirational Story

The great fire and the little water

Among the Aztec people of Mexico, it is said that a long time ago there was a great fire in the forests that covered our Earth. People and animals started to run, trying to escape from the fire. Our brother owl, Tecolotl, was running away also when he noticed a small bird hurrying back and forth between the nearest river and the fire. He headed towards this small bird.

He noticed that it was our brother the Quetzal bird, Quetzaltototl, running to the river, picking up small drops of water in his beak, then returning to the fire to throw that tiny bit of water on the flame. Owl approached Quetsal bird and yelled at him: "What are you doing brother? Are you stupid? You are not going to achieve anything by doing this. What are you trying to do? You must run for your life!"

Quetzal bird stopped for a moment and looked at owl, and then answered: "I am doing the best I can with what I have."

It is remembered by our Grandparents that a long time ago the forests that covered our Earth were saved from a great fire by a small Quetzal bird, an owl, and many other animals and people who got together to put out the fire.

Source: "Turning To One Another" by Margaret Wheatley


Reades Response

1. Dear Dr  Aggarwal, For the last whole month I have been tavelling widely in U. K. and U S A. I have never felt away from the medical world or from India because every day whether it was in the remotest area of Alaska or in the centre of London I have read every single day  emedinews. Thank you for bringing out this fascinating publication  and congratulations. Best Wishes, Yours sincerely, Dr. Ranjit Roy Chaudhury ( Member Board of Governors MCI)

Dear Dr. Aggarwal, Thanks for the mail. I must congratulate you for starting this service which now will be readily available to the readers. I am sure many other disciplines would and should start providing similar facility . Please keep me informed, Thanks. Sincerely, Saroj Srivastava, President Elect IMS 2011

Dear Dr K.K.Aggarwal, I must congratulate for your efforts to bring out well balanced e-medinewsletter. It is very informative & interesting. To-day is Guru Purinima & paper has brougt out quality of good teaching. Further this paper has mentioned a true story of a teacher ,how much a teacher is important to students & how much students are important to a teacher. Teacher & students have very senstive & emotional relationship. I  am teaching medical Pharmacology &Therapeutics for last 42 years with out a gap of single day, I wish you all success. With thanks, Dr. A K Kela, Former Director - Prof & HOD, Lady Harding Medical College, Former Presidet (int) Indian Pharmacology Sociaty, Presntly Prof & H.O.D ,S.R.D.C,Faridabad.

IJCP Special

Dr Good Dr Bad

Situation: A patient with pain in abdomen was found to have a TLC > 20000.
Dr Bad: Repeat TLC.
Dr Good: Rule out liver abscess.
Lesson: In liver abscess, the TLC is typically > 15000.

Make Sure

Situation: A 36–year–old truck driver had severe allergic rhinitis and came for treatment.
Reaction: Oh my God, why was he not prescribed azelastine nasal spray?
Lasson: Make sure to avoid oral antihistamines in persons who perform tasks like driving as they may cause sedation and drowsiness; instead prescribe azelastine nasal spray which is effective and non–sedating.

Quote of the Day

"First we make our habits then our habits make us." John Dryden

Are you fit to fly?

Nasal and sinus disease

  1. Commercial air travel is contraindicated for patients with severe sinusitis, large obstructing polyps, recent nasal or facial surgery, or severe recurrent epistaxis (nasal bleed).

  2. Such conditions can obstruct sinus opening preventing pressure equilibration and predisposing to extension of disease into the eye and brain.

For patients with allergic rhinitis, oral anti allergics and nasal steroids are helpful


International Medical Science Academy Update (IMSA)

The choking game

In a 2008 survey of eighth–graders attending public schools in Oregon, 5.7 percent of respondents reported that they had participated in the self–strangulation activity known as "the choking game"


"Choking game" awareness and participation among 8th gradersOregon, 2008. MMWR Morb Mortal Wkly Rep 2010;59:1.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Injection (Addl.Indication)

Treatment of acute STsegment elevation myocardial infarction including patients to be managed medically or with subsequent percuaneous coronary intervention (PCI)



Medi Finance

Q: Is revenue expenditure for research related to business allowed as deduction?

Ans. Any revenue expenditure for research related to business is allowed as deduction.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Tests for Conn’s Syndrome

  • To diagnose primary hyperaldosteronism and to monitor the effectiveness of treatment
    • Blood renin
    • Blood and/or 24–hour urine aldosterone
  • To screen for primary hyperaldosteronism
    • Aldosterone–renin ratio (ARR)

If renin levels are low and aldosterone high, then the ratio will be significantly increased and primary hyperaldosteronism is likely to be present.


Humor Section


Memory Test

Doctor: You're in good health. You’ll live to be 80.
Patient: But, doctor, I am 80 right now. Doctor: See, what did I tell you.

Medical bloopers on medical charts!

The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.


Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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