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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 …

27th October 2011, Thursday

Facts about tea, coffee and cola drinks

  1. Caffeine is consumed in coffee, tea, soft drinks, and small amounts in chocolate.
  2. It is the most widely used pharmacologically active substance in the world.
  3. Caffeine can acutely raise blood pressure by 10 mmHg in patients who are infrequently exposed.
  4. There is no effect on blood pressure in habitual coffee drinkers
  5. It does not increase the risk of incident hypertension.
  6. There is no evidence that caffeine in doses used in routine can provoke a spontaneous arrhythmia in individuals with or without a history of cardiac arrhythmia. There is no protective effect of caffeine abstinence also. In heart patients with coronary disease, the risk may be increased in individuals who are slow metabolizers of caffeine and drink two or more cups of coffee per day.
  7. Ingestion of large quantities of caffeine is associated with arrhythmic and cardiovascular events, especially in patients with underlying cardiac disease.
  8. Patients with a history of cardiac arrhythmia or at increased risk for cardiovascular events should moderate their caffeine intake from all sources.
  9. Consumption of caffeinated beverages is associated with some short-term benefits like increased mental alertness and improved athletic performance.
  10. Consumption of caffeinated beverages is associated with short term adverse effects including headache, anxiety, tremors, and insomnia.
  11. In the long term, caffeine is also associated with generalized anxiety disorder, depression, and substance abuse disorders.
  12. Long term benefits of caffeinated beverages are dose-dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout.
  13. Both caffeinated and decaffeinated coffee are associated with a lower risk of type 2 diabetes.
  14. Several studies have linked coffee consumption with prevalence of various cancers.
  15. The majority of studies show there may be a modest inverse relationship between coffee consumption and all-cause mortality.
  16. Caffeine withdrawal is a well-documented clinical syndrome with headache being the most common symptom. (Source Uptodate)

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 on

Facts about tea, coffee and cola drinks

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011 – Impact of climate change on family health

Doctors in a large number register themselves for the conference and took active participation also.

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


Medical council to review eradication programme

India's staggering new-case detection rate in leprosy last year — it has recorded 64 per cent of the total new cases detected all over the world — has prompted Indian Council of Medical Research (ICMR) to call for fresh proposals to evaluate the National Leprosy Eradication Programme (NLEP). While leprosy eradication has been defined by WHO to be less than one case in a population of 10,000, over 200 districts of India in parts of Bihar, Madhya Pradesh, Maharashtra and Tamil Nadu recorded more numbers last year. “Leprosy eradication is one of the success stories of the public health programme in India, notwithstanding the continuing emergence of new cases from some pockets,” says ICMR director general Dr V M Katoch. “We are trying to revamp the NLEP in two directions to consolidate our gains: one, to specifically target these areas; and second, to ensure that the success we have achieved is not reversed.” (Source: Indian Express, Oct 24 2011)

For comments and archives

WHO says 50pc tribal deaths in state due to malaria

BHOPAL: The World Health Organisation (WHO), hopes that a quarter of the countries would be able to eliminate malaria in about a decade but, it will continue as an endemic disease in Madhya Pradesh and some other parts of India. The WHO study suggests that in Madhya Pradesh, Malaria spreads primarily because of vast tracts of forest with tribal settlement. With over 30 per cent of malaria cases in India having an estimated 84 million tribal population, 50 per cent of deaths are caused due to malaria making it the world's third deadliest killer after AIDS and tuberculosis," said Regional Medical Research Centre's (RMRC) National Institute of Malaria Research (Jabalpur) Director Neeru Singh. She further said, "Despite taking several measures for prevention and control of malaria, falciparum malaria remains uncontrolled and deaths due to malaria have increased. (Source: TOI, Oct 20, 2011)

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

(Dr Monica and Brahm Vasudev)

Triple-drug therapy for IPF found unsafe

A triple-drug regimen for idiopathic pulmonary fibrosis (IPF) that was deemed a medical success just 6 years ago produced worse outcomes, including greater mortality, than a placebo or inactive substances in a 3-arm, multicenter clinical trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The combination of prednisone, azathioprine, and N-acetylcysteine (NAC) was considered so unsafe for patients taking it that their arm of the trial was halted prematurely, the NHLBI announced today. The agency is a part of the National Institutes of Health (NIH). (Source: Medscape Medical News)

For comments and archives

Simple test detects occult eye injury after combat blast

Specular microscopy is a useful screening test for detecting occult ocular injury in veterans exposed to combat blast, and might prove useful as a baseline screening test before the deployment of military personnel, according to research presented here at the American Academy of Ophthalmology 2011 Annual Meeting. (Source: Medscape Medical News)

For comments and archives

MRI detects early joint changes in RA

Subtle, pre-erosive joint changes that presage irreparable articular damage, and are detectable only on MRI, were prevented in patients with rheumatoid arthritis treated with the biologic agent golimumab (Simponi), researchers found. In a subanalysis of a randomized trial known as GO-FORWARD, 12 weeks of treatment with golimumab plus methotrexate resulted in a change on MRI scores for wrist and metacarpophalangeal synovitis of -1.77 compared with a change of -0.15 (P<0.001) for placebo plus methotrexate treatment, according to Philip G. Conaghan, MD, from the University of Leeds in the U.K., and colleagues. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Valedictory Function, 23rd Oct. 2011, VALEDICTORY FUNCTION, MTNL Perfect Health Mela 2011, 23rd October,

@DeepakChopra: CosmicConsciousness Neutrino and Quark are the parents of the universe #cosmicsociety

    Spiritual Update

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

You can win over death: the science behind Dhanteras

Dhanteras is also observed in worshipping Lord Yama: the God of death. On this day the “Owl” form of Goddess Laxmi is worshiped. When the Gods and demons churned the ocean for Amrita or nectar, Dhanvantari also emerged carrying a jar of the elixir (wealth of wisdom) on this day.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Chasing meaningless goals

A farmer had a dog that used to sit by the roadside waiting for vehicles to come around. As soon as one came he would run down the road, barking and trying to overtake it. One day a neighbor asked the farmer "Do you think your dog is ever going to catch a car?"

The farmer replied, "That is not what bothers me. What bothers me is what he would do if he ever caught one." Many people in life behave like that dog who is pursuing meaningless goals.

To live a meaningful life, choose meaningful goals!

For comments and archives

    Fitness Update

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

The endorphin fitness ‘myth’

It’s now questionable whether endorphins play much of a part at all in why exercise makes us feel good. This is because there are two endorphin systems in the body – one in the blood circulatory system, and the other in the brain. And although it’s been proven that endorphin levels in the blood increase in response to exercise, those endorphins can’t cross the ‘blood-brain barrier’, so wouldn’t necessarily have much of an effect on mood. So what is putting that smile on your face when you work out? Researchers now believe that there are a multitude of factors at work – both physiological and psychological.

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Who is not fit to drive?

Loss of vision in one eye does not prevent driving, provided that the person has adjusted to it. Glaucoma, colour blindness and cataracts do not mean you cannot drive, provided you meet the standards required.

    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What the National Drug Policy of India says

Chemotherapy of severe and complicated malaria

Initial parenteral treatment for at least 48 hours:
CHOOSE ONE of following four options

Follow-up treatment,
when patient can take oral medication following parenteral treatment

Quinine: 20mg quinine salt/kg body weight on admission (IV infusion or divided IM injection) followed by maintenance dose of 10 mg/kg 8 hourly; infusion rate should not exceed 5 mg/kg per hour. Loading dose of 20mg/kg should not be given, if the patient has already received quinine.

Quinine 10 mg/kg three times a day with:

Doxycycline 100 mg once a day
 Clindamycin in pregnant women and children under 8 years of age,

• to complete 7 days of treatment.

Artesunate: 2.4 mg/kg IV or IM given on admission (time=0), then at 12 h and 24 h, then once a day.


Artemether: 3.2 mg/kg body weight IM given on admission then 1.6 mg/kg per day.


Arteether: 150 mg daily IM for 3 days in adults only (not recommended for children).

Full course of ACT

Note: The parenteral treatment in severe malaria cases should be given for minimum of 24 hours once started (irrespective of the patient’s ability to tolerate oral medication earlier than 24 hours).

    Medicine Update

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

What is the role of percutaneous drainage in management of liver abscess?

Percutaneous drainage is indicated in management of liver abscesses that require more than just a medical management. Even multiloculated liver abscesses can be managed with aggressive percutaneous techniques that include disruption of loculations and placement of large bore catheters. Indications are:

  • Volume of abscess is large and there is risk of spontaneous rupture (specially left lobe abscesses).
  • When actual rupture has occurred, then along with abscess cavity drainage of extraneous collection.
  • When there is lack of response to medical therapy.
  • When there is evidence of liver failure.

Absence of a secure route is the only contraindication.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Increased: Renal failure including prerenal, drug-induced (aminoglycosides, vancomycin), acromegaly.
Decreased: Loss of muscle mass, pregnancy.

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was diagnosed with sarcopenia.
Dr. Bad: It is related to diabetes.
Dr. Good: It is not related to diabetes.
Lesson: In the Korean Sarcopenic Obesity Study (KSOS), type 2 diabetes was associated with increased risk of sarcopenia. These characteristics may contribute to physical disability and metabolic disorders in older adults with diabetes.

For comments and archives

Make Sure

Situation: A patient who had multiple blunt trauma on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt trauma to exclude peritoneal hemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

For comments and archives

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  Quote of the Day

(Dr GM Singh)

It is from numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope. Robert Francis Kennedy


A chip on your shoulder: Being upset for something that happened in the past.

    Mind Teaser

Read this…………………

little LARGE
little LARGE
little little
little LARGE

Yesterday’s Mind Teaser: Q. Which one of the following statements is true regarding water reabsorption in the tubules?
1. The bulk of water reabsorption occurs secondary to Na+ reabsorption.
2. Majority of facultative reabsorption occurs in proximal tubule.
3. Obligatory reabsorption is ADH dependent.
4. 20% of water is always reabsorbed irrespective of water balance.

Answer for Yesterday’s Mind Teaser: 1. The bulk of water reabsorption occurs secondary to Na+ reabsorption.

Correct answers received from: Dr KV Sarma, YJ Vasavada, Dr Anupam,  Dr HL Kapoor, Dr K Raju, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Sukla Das, Dr PC Das, Dr Uma Vasanth

Answer for 25th October Mind Teaser
: You can't take pictures with a wooden leg. You need a camera to take pictures.
Correct answers received from:  Dr Shirish Singhal, Dr HL Kapoor, Dr K Raju, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Fiza, Dr Mahak, Dr Shagun, Dr Rashi.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Anil Kumar Jain)

A man received a letter from some kidnappers. The letter said, "If you don't promise to send us $100,000, we promise you we will kidnap your wife." The poor man wrote back, " I am afraid I can't keep my promise but I hope you will keep yours."

    Medicolegal Update

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

Precautions in Sampling of blood in forensic cases……………..

  • The site of injection should be cleaned by saline swab and not by spirit swab if the sample of blood is collected for alcohol estimation
  • About 3-4 ml of blood is drawn as sample in chemically clean evacuated tubes of 5ml.
  • set of water proof /not be vulnerable to freezing labels with identification codes to mark the tubes should be used
  • EDTA should be used as anticoagulant. Tubes with liquid EDTA /fluoride reduce the risk of hemolytic leads to altered results
  • 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde or 0.5% w/v of formalin solution must be added to prevent decomposition which leads to altered results
  • Plastic vacuum tubes/ Plastic vacuum gel tubes are preferred to glass tubes. . If vacuum tubes are not available or tubes are opened for freely flowing samples, stoppers which do not react with blood constituents should be available.
  • special boxes for tube transfer and storage, earmarked refrigerator/ freezer must be available in hospital conducting medico legal cases
  • About 3-4 ml of blood is taken in a sterile 5ml injection vial( properly sealed and labeled) containing about 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde (or 0.5% w/v of formalin solution).
  • Two approximately 1cm x 1cm size blood stains are formed on clean cotton cloth/gauze pieces and, after they are dry, they are transferred to a sterile 10ml injection vial it should be properly dried, before packing to avoid decomposition and then sealed & labeled.
  • Bloodstains located on the body of an injured person are taken by rubbing with moistened clean cotton cloth pieces, it should be properly dried, before packing to avoid decomposition and then sealed & labeled.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

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

Gift for your Sister on Bhai Duj

The best gift you can give your sister on Bhai Duj is a healthy heart check recommends Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Most diseases remain silent for years or decades. Blood pressure, diabetes and high cholesterol may remain silent for over two decades.

The doctors recommend an annual physical checkup after the age of 30 for Indians as against 40 in Americans.

If there is a family history, the checkup may be done earlier starting at age 20 and if normal every three years till the age of 30 when one should start annual checkups.

Special tests needed by women are breast mammogram ( after age 50), ultrasound of the pelvis, bone and fat densinometry, cervical cancer checkups and special ante natal checkups if they are pregnant.

If detected early both cancer of the breast and cancer of the cervix are curable.

Osteoporosis is another condition rampant in women and needs a regular checkup. The disease remains silent till a fracture comes. In India heart disease amongst women is also at its rise.

Collectively more women die of heart attack than all types of cancers combined together.

Most corporate hospitals today can either give a coupon or issue an advance receipt which can be utilized by the sister for a checkup.

Coronary heart disease is the leading cause of death among women. Between the ages of 45 to 64, one in nine women develop symptoms of some form of cardiovascular disease. After age 65, the ratio climbs to one in three women. The best gift one can give to the middle aged sister is to have her cardiac check up done using a stress echocardiography.

Diagnosing coronary heart disease in the woman who presents with chest pain can be a difficult problem. Coronary angiography is considered the "gold standard" for diagnosis but is an invasive and costly test.

The initial evaluation of patients presenting with chest pain and suspected heart disease often includes some form of stress testing. Ordinary stress treadmill test in the women maybe unreliable. The best answer is to get a stress exercise echocardiography done. The sensitivity and specificity of stress echocardiography is high.

For comments and archives

    Readers Responses
  1. Dear Dr. Aggrawal, You and your team are working hard. Dr.B.R.Bhatnagar
    Forthcoming Events

GP CON 2011

National Conference of IMA CGP
Date: October 29th–30th, 2011
Venue: Savera, Chennai
IMA CGP HQ is organizing a two day CME, Group discussion and Workshop pertaining to Family Medicine Concept, Which will be a "Reincarnation" of the traditional Family Doctor Concept in India.
More details Contact Conference Secretariat, Dr TN Ravisankar,
email:imacgp.chennai@yahoo.com; website:imacgpindia.com

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

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

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

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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 Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta