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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

  Editorial …

27th April, 2011, Wednesday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Types of death

With the death of Bhagwan Sai Baba, a curiosity has arisen in the minds of the people about the different types of deaths.

As per Jainism, there are three types of Saints. Firstly, the Sadhu or the Saint; secondly, the Siddha ones and thirdly, the Arihant ones. Sadhu and saints can be equated to Rishis in Hinduism. These are the people who attain balance between loss and gain. The Siddha saints can be equated to Maharishis in Hinduism and these are the people who have attained unusual Siddhi powers. In Jainism, there is another category ‘Arihant’ and these are the people who are beyond Kaam, Krodh, Ahankar or, in other words, are the people who have attained Moksha or inner happiness.

As far as death is concerned, it can be of many types. There is a term called Santhara in Jainism, which indicates ichha mrityu and is usually adopted by Rishi Munis when they decide their date of leaving the body. One such classical example was Acharya Vinoba Bhave who declared that he would leave his body after ten days on the date of Amavasya and it happened.

The second mode of death is routine death that we see in day to day life. The third mode of death is ‘Nirvana’ and is used for Siddha people who attain Samadhi or leave the physical body and their followers keep them alive through their teachings and work. It is presumed that they have only left the physical body and have not died. This is what happened to Maharshi Mahesh Yogi and Swami Chinmayananda.

Many people including Acharya Rajnish were called Bhagwan during their lifetime. The question always comes whether they were born as Bhagwan or not. The answer comes in two terms described in Jainism. Firstly, Avtaravad which is defined as descent of God to manhood and the second term is Uttaravad which is ascent of man to Godhood. Whether a particular saint belongs to Avataravad or Uttaravad is decided by the collective consciousness of the society and/or of their followers. The terms used for Maharishi and Siddha people when they depart from this universe are Brahmleen Nirvan Samadhi etc. and not death.

Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Resource which has changed practice in last one year

Pertussis vaccination

  • The ACIP has voted to recommend that a single dose of Tdap vaccine may be given in place of Td for adults aged 65 years and older who have not previously received Tdap. (November 12, 2010)
  • Vaccines containing tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) have been approved since 2006 for booster vaccination in individuals aged 10 to 64 years.
  • The addition of the pertussis component to tetanus/diphtheria booster immunization reduces the incidence of pertussis infection in both vaccine recipients and, more importantly, their infant contacts.
  • In the fall of 2010, the Advisory Committee on Immunization Practices (ACIP) also voted to recommend that a single dose of Tdap vaccine may be given in place of Td for adults ≥65 years who have not received Tdap.(1,2)
  • This is important for older adults who have close contact with infants (such as grandparents, child care providers and health care providers). These recommendations are expected to be published with the ACIP’s 2011 recommended adult immunization schedule.


  1. http://www.cdc.gov/vaccines/recs/acip/slides–oct10.htm (Accessed on November 10, 2010).
  2. http://www.reuters.com/article/idUSTRE69Q5UL20101027 (Accessed on November 15, 2010).
    eMedinewS Audio PostCard

HIV Update

Dr Nalin Nag Speaks on
‘Therapy for HIV infection’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2011

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal presented Distinguished Service Award to Ms Kusum Kathuria, Vice Principal, DPS, Mathura Road on 21st April on the occasion of World Earth Day.

Dr K K Aggarwal
    National News

MCI to consider telemedicine’s ethical efficacy

With the concept of telemedicine fast catching the fancy of the healthcare sector, the Medical Council of India (MCI) has decided to look into its ethical aspects. Till now, its cost effectiveness and practical ways to deliver services to the patient’s doorstep have only increased popularity, especially in remote areas. A large number of super–specialty and Government hospitals are opting for telemedicine facilities, which envisage transfer of a patient’s medical data — demographical information and history, images like X–ray, CT scan and MRI for diagnosis, treatment as well as clinical consultation — in electronic format. However, currently, in India there is no law on the e–health and in its absence there is no check on such facilities in case of any medication errors or medical violations by them. Dr SK Sarin, chairman of the MCI board of governors, while underlining the increasing need for such facilities to reach out to far–flung areas, felt that one has to ensure that it is not misused. (Source: The Pioneer, April 23, 2011)

Single test proposed for engineering admissions

NEW DELHI: Close on the heels of the decision to conduct a common entrance test for undergraduate medical courses, the government proposes to hold a single test for admissions to engineering and technical courses, including in the Indian Institutes of Technology, too. The proposed National Aptitude Test will annually benefit more than seven lakh students, who at present have to take multiple examinations to get into engineering. The objective "is to reduce psychological and financial stress on students and give more emphasis to Class 12 results than coaching," T. Ramaswamy, Secretary, Department of Science and Technology, has said in his report. He was entrusted with taking a re–look at the test methodology of selections and having a common system for admissions to the IITs, the Indian Institutes of Science, Engineering and Research, the National Institutes of Technology and other engineering colleges. (Source: The Hindu, Apr 22, 2011)

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 Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Health – Important Tips

  • Do not drink coffee TWICE a day.
  • Do not take pills with COOL water.
  • Do not have HUGE meals after 5pm.
  • Reduce the amount of OILY food you consume.
  • Drink more WATER in the morning, less at night.
  • Keep your distance from hand phone CHARGERS.
  • Do not use headphones/earphone for LONG period of time.
  • Best sleeping time is from 10pm at night to 6am in the morning.
  • Do not lie down immediately after taking medicine before sleeping.
  • When battery is down to the LAST grid/bar, do not answer the phone as the radiation is 1000 times.

(Dr Monica and Brahm Vasudev)

Too much television may increase future cardiovascular risk for children

Young children who spend too much time watching TV or playing computer games have narrower eye arteries than kids who are more physically active, according to a study published online in Arteriosclerosis, Thrombosis and Vascular Biology: Journal of the American Heart Association.

Young Indian adults developing more risk factors for heart disease

Increasingly, young adults residing in urban areas of India are developing hypertension, obesity, and diabetes, which suggests that the country may soon experience an increase in heart disease rates, according to a study published in the Journal of the American College of Cardiology.

Higher death rates seen in kidney failure patients through central line catheter

Ass per the American Society of Nephrology wrote, Patients on peritoneal dialysis (PD) typically have a higher early survival rate than patients on hemodialysis (HD). New data suggest that this difference may be explained by a higher risk of early deaths among patients undergoing HD with central venous catheters, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

    IJCP Special

Dr Good Dr Bad

Situation: A patient of dengue hemorrhagic fever with minor GI bleed came for evaluation.
Dr Bad: Sister, admit him for platelet transfusion.
Dr Good: Sister, admit him for observation.
Lesson: Minor bleeds do not require platelet transfusion unless the bleeding is profuse and hematocrit is high. No blood transfusion is needed.

Make Sure

Situation: A patient with asymptomatic second degree Mobitz 1 block after PPI developed lead infection.
Reaction: Oh my God! Why was PPI (Permanent pace maker implantation) done?
Lesson: Make sure that PPI is not implanted in patients with asymptomatic second–degree Mobitz I (Wenckebach) AV block.

    An Inspirational Story

(Dr Prachi Garg)

A life that makes a difference

An elderly nurse believed there was hope, however, and she made it her mission to show love to the child. Every day she visited Little Annie. For the most part, the child did not acknowledge the nurse’s presence, but she still continued to visit. The kindly woman left cookies for her and spoke words of love and encouragement. She believed Little Annie could recover, if only she were shown love. Eventually, doctors noticed a change in the girl. Where they once witnessed anger and hostility, they now noted an emerging gentleness and love. They moved her upstairs where she continued to improve. Then the day finally came when this seemingly "hopeless" child was released.

Anne Sullivan grew into a young woman with a desire to help others as she, herself, was helped by the loving nurse. It was she who saw the great potential in Helen Keller. She loved her, disciplined her, played with her, pushed her, and worked with her until the flickering candle that was her life became a beacon of light to the world. Anne Sullivan worked wonders in Helen’s life, but it was a loving nurse who first believed in Little Annie and lovingly transformed an uncommunicative child into a compassionate teacher. "If it had not been for Anne Sullivan, the name of Helen Keller would have remained unknown." But if it had not been for a kind and dedicated nurse, the name of Anne Sullivan would have remained unknown. And so it goes. Just how far back does the chain of redemption extend? And how for forward will it lead?

Those you have sought to reach, whether they be in your family or elsewhere, are part of a chain of love that can extend through the generations. Your influence on their lives, whether or not you see results, is immeasurable. Your legacy of dedicated kindness and caring can transform lost and hopeless lives for years to come.

You can never overestimate the power of your love. It is a fire that, once lit, may burn forever.

    Pediatric Update

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

What are the features of appendicitis in a preschool age group (2–5 years)?

Appendicitis is still rare at this age, with children 5 years or younger accounting for less than 5% of all paediatric appendicitis.

  • Abdominal pain (89% to 100%), vomiting (66% to 100%), fever (80% to 87%), and anorexia (53% to 60%) predominate.
  • In contrast to infants, right lower quadrant tenderness is more common.
  • Vomiting is often the first symptom noted by parents and a history of vomiting that precedes pain is common.
    ENT Update

Dr. Aru Handa MS, DNB (Dept Co–ordinator and Senior Consultant, Dept. of ENT, Moolchand Medcity)

What is leukoplakia?

Leukoplakia means a "white patch" which is commonly seen on tongue, cheek mucosa or floor of mouth. It is a pre cancerous condition; about 4–6% of these lesions can develop into oral cancer. The lesion can be homogenous in appearance, speckled or verrucous type. The homogenous type may be asymptomatic and has the least potential to become malignant. Others, especially the proliferative verrucous type, are more likely to become malignant and may be associated with pain and burning sensation. Prolonged irritation, tobacco chewing, smoking and alcohol consumption are some of the etiological factors. Biopsy is required to confirm the diagnosis. Management includes elimination of etiologic factors. Retinoids, beta–carotene and various other antioxidants are recommended. Larger lesions not responding to medical management may be subjected to laser excision.

    Medicolegal Update

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

What did the Attorney General of India say in the Aruna Shanbaug case?

Learned Attorney General stated that the report of The Law Commission of India on euthanasia has not been accepted by the Government of India.

  • He further submitted that Indian society is emotional and care-oriented. We do not send our parents to old age homes, as it happens in the West. He stated that there was a great danger in permitting euthanasia that the relatives of a person may conspire with doctors and get him killed to inherit his property. He further submitted that tomorrow there may be a cure to a medical state perceived as incurable
  • In common law it is the right of every individual to have the control of his own person free from all restraints or interferences of others. Every human being of adult years and sound mind has a right to determine what shall be done with his own body. In the case of medical treatment, for example, a surgeon who performs an operation without the patient’s consent commits assault or battery.
  • It follows as a corollary that the patient possesses the right not to consent i.e. to refuse treatment. In the United States this right is reinforced by a Constitutional right of privacy. This is known as the principle of self–determination or informed consent.
  • The principle of self–determination applies when a patient of sound mind requires that life support should be discontinued. The same principle applies where a patient’s consent has been expressed at an earlier date before he became unconscious or otherwise incapable of communicating it as by a ‘living will’ or by giving written authority to doctors in anticipation of his incompetent situation. Mr. Andhyarujina differed from the view of the learned Attorney General in that while the latter opposed even passive euthanasia, Mr. Andhyarujina was in favour of passive euthanasia provided the decision to discontinue life support was taken by responsible medical practitioners.
  • If the doctor acts on such consent there is no question of the patient committing suicide or of the doctor having aided or abetted him in doing so. It is simply that the patient, as he is entitled to do, declines to consent to treatment which might or would have the effect of prolonging his life and the doctor in accordance with his duties has complied with the patient’s wishes.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Diabesity – A deadly new cocktail of sugar and fat

What is Bariatric and Metabolic Surgery?

Weightloss surgery was seen to help control other metabolic problems like type 2 diabetes, high blood pressure and high cholesterol. Control of these three risk factors decreases the risk of heart and vascular disease, while also decreasing inflammation in the body.

There are four surgical procedures approved by the American Society for Metabolic and Bariatric Surgery and the American College of Surgeons that can be used to treat obesity and metabolic disease. The procedures can cause a restriction of calories, change the way in which hormones contribute to hunger and a feeling of fullness or re–route the food so that not all the food is absorbed (malabsorption). When the procedure causes malabsorption of calories, it also causes malabsorption of protein, vitamins and minerals, some of which have to be replaced. For the remission of type 2 diabetes, the most important question is whether the food goes through a part of the intestine called the duodenum. Those procedures are more effective in the management of diabetes. The chart below shows a comparison of these four procedures.


Restricts the amount of food

Affects Hormones

Food not absorbed

Bypass Duodenum


Adjustable Gastric Band





Sleeve Gastrectomy





Gastric Bypass






Duodenal Switch/BPD






    Mind Teaser

Read this………………… 


Yesterday’s Mind Teaser: Eye E
See Except

Answer for yesterday’s Mind Teaser: Eye before E, Except after See (‘i’ before ‘e’, except after ‘c’)

Correct answers received from: Dr Sudipto Samaddar, Dr Nandini Kapoor.

Answer for 25th April Mind Teaser:Change of Plans
Correct answers received from: Dr U Gaur.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

Funny definitions

Gastrointestinal: "The alimentary canal is located in the northern part of Alabama."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Low platelet counts and bleeding

  • In idiopathic thrombocytopenic purpura, minimal bleeding after trauma is uncommon unless the platelet count is less than 60,000/microL.
  • Self–limited bleeding, spontaneous bleeding requiring special attention (eg, nasal packing for epistaxis), and severe life threatening bleeding does not occur until platelet counts are <40,000, <12,000, and <6000/microL, respectively.
    Medi Finance Update

(Dr GM Singh)

Can I use PAN to pay the TDS deducted into government account?

No. You are required to take a separate Tax Deduction Account Number (TAN) by making an application in form 49B with the TIN Facilitation Center of NSDL.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Flupirtine Maleate Capsules 100mg

For treatment of acute and chronic pain i.e., for painful increased muscle tone of the posture and motor muscles, primary headache, tumor pain, dysmenorrheal and pain after traumatologic/orthopedic operations and injuries.


    IMSA Update

International Medical Science Academy (IMSA) Update

Maintenance rituximab in follicular lymphoma

For patients with newly diagnosed follicular lymphoma who have had at least a partial response to initial therapy, go for maintenance rituximab rather than observation. (J Clin Oncol 2010;28:574s)

  Quote of the Day

(Dr GM Singh)

One resolution I have made, and try always to keep, is this: To rise above the little things. John Burroughs

    Readers Responses
  1. Dear brother Dr. KK, Thanks for putting up Bhagwan Sri Sathya Sai Baba’s NIRVANA. We are ardent devotees of HIM and both myself and my wife had the GREATEST FORTUNE to Serve Him at Puttaparthy Hospital/s from 1991–1998 both our daughters studied there. We received so much of His Divine Love and Blessings, hundreds of times. I wrote a book "The Dreams and Realities…Face to face with God"… it carries my experiences TRUTHFULLY related with HIM. In REALITY I see Him Leaving as His OWN DIVINE WISH. People say so many types of things and have not spared anyone as Avtar. I do not wish any controversies to start, BUT SURELY THE GREAT HUMAN SERVICE TASKS that Swami has undertaken, need to be ADORED by one and all. I worked there as Blood Bank I/C and KNOW FOR GRANTED that SEVERAL FIRSTS in our country started there including Apheresis (COBE Spectra), HCV Testing, Leucoreduction, Computerization, 100% Voluntary Blood Donations (people from 110 Nationalities had donated blood). Hundreds of Units were given FREE OF COST for Cancer patients etc. TREATMENT WAS ABSOLUTELY FREE FOR ONE AND ALL. I REDEDICATE my LIFE TO MY LOVE MY LIFE AND MY LORD BHAGWAN SRI SATHYA SAI……………May He INSPIRE us all to be a BIT of Him. God Bless. Dr. NK Bhatia
    Public Forum

(Press Release for use by the newspapers )

Remember the health windows

The window for the deadliest form of heart attack called ST–elevation myocardial infarction (STEMI), ideally is within 30 minutes for clot–dissolving drug treatment, and within 90 minutes for angioplasty. Window means the period before which the specific treatment should start, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India. Thirty percent of STEMI patients do not get clot–busting drugs. Twenty percent are not candidates for clot–busting drugs and, of these, 70 percent do not get angioplasty.

The window period for the paralysis patient to receive the clot dissolving drug is also 3 hours.

The earlier definition of transient ischemic attack (or mini paralysis) "focal neurologic symptoms of ischemic cause that last less than 24 hours" has now changed to "a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than 1 hour, and without evidence of acute infarction." The paradigm shift is so that more and more number of cases can get clot–dissolving drugs.

For a victim of road traffic accident, the window to shift the patient is 10 minutes, called ‘Platinum Ten minutes’ and the victim to get basic resuscitation done is one hour called ‘Golden Hour’.

    eMedinewS Special

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

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

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

  Towards Well Being


    Forthcoming Events

May 7–8, 2011, National Seminar On Stress Prevention

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com


September 30 – October 02, 2011; XVIth World Congress on Cardiology, Echocardiography & Allied Imaging Techniques
Venue: The Leela Kempinski, Delhi (NCR), September 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.

Dr (Col) S.K. Parashar, President, e–mail: drparashar@yahoo.com, Mob:09810146231
Dr Rakesh Gupta, Secretary General, email:jrop2001@yahoo.com, Mob:09811013246
Congress Secretariat: Rajat Khurana, C-1 / 16, Ashok Vihar – Phase II, Delhi 110 052, India, Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011
(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)

Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES and Dept of Health and Family Welfare Govt of NCT of Delhi.

Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).

Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/ Mr M Malik at


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    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 Naveen Dang, Dr. Parveen Bhatia, Dr Prabha Sanghi, Dr Prachi Garg, Dr. Pulkit Nandwani, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta.