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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

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  Editorial …

28th May 2013, Tuesday


Fever does not mean presence of infection. There are many situations where there is fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36 oC to 38.30oC. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs.
  • Hyperthermia may not respond to anti-fever drugs.
  • When fever is more than 41.5oC, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti-fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

For Comments and archives…

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

Obesity reduces life expectancy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2013

Heart Care Foundation of India and World Fellowship of Religions in association with Ministry of Earth Sciences Govt. of India and Delhi Public School Mathura Road observed World Earth Day 2013.

Dr K K Aggarwal
    National News

DCGI working on policy to respond to safety alerts by foreign regulators

NEW DELHI: India's drug regulator is working on a clear policy on how it should respond to safety alerts by foreign regulators on medicines manufactured by Indian companies after two of the country's biggest drug manufacturers landed in trouble with the US watchdog.

Last week, the US Food and Drug Administration (US FDA) blocked imports of all but one drug manufactured at the Aurangabad facility of Wockhardt. Earlier this month, Ranbaxy had pleaded guilty and agreed to pay a $500-million fine to the US government to settle criminal and civil charges against it. Wockhardt's chairman Habil Khorakiwala on Thursday projected that the firm may take an annual hit of $100 million as a result of the US FDA action.

The Drugs and Cosmetics Act does not empower the drug regulator to take action based on a red-flag raised by a foreign counterpart. In future, Indian government may take a cue from the action of foreign drug regulators, but it would assess the good manufacturing practices of Indian firms according to the Indian law (Drugs and Cosmetics Act).

"While the Indian law is based purely on science, law and actions of other countries may be influenced by several factors, including patent policies and commercial interests of respective countries," GN Singh, the Drug Controller General of India (DCGI) told ET. Indian drugmakers export to over 200 countries, most of which have their own laws and regulators to keep a check on the quality of drugs.

"The regulatory regimes of different countries vary. There is no one set of globally harmonised good manufacturing practices, against which, one can benchmark and pronounce verdicts which can apply universally," said Singh. "My mandate is to ensure quality, safety and efficacy of drugs marketed in the country. While alerts by other regulators can help raise scrutiny levels here, our decisions would strictly be based on what has been clearly laid down as the law of the land," the drug regulator added.

Indian drugmakers also feel that DCGI should act as per the mandate defined by Parliament for the regulator, which reflects "national needs". "Our drug regulator acts on behalf of Parliament and has a clear remit under the Drugs and Cosmetics Act. It is important that the underlying sanctity of that law is preserved," said DG Shah, secretary general, Indian Pharma Alliance, an industry body representing domestic drugmakers. (Source: Economic Times, 27 May, 2013)

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, every Thursday 4:30 PM in DD India

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

Mild rheumatic mitral regurgitation is usually well tolerated and the patient often remains asymptomatic for years. These patients should be seen annually. Patients with moderate MR should be seen and undergo echocardiography yearly or sooner if symptoms occur. Patients with severe mitral regurgitation should be seen at least every 6 to 12 months to monitor for the development of symptoms by clinical examination and LV systolic dysfunction by echo. Presence of LV dysfunction (EF <0.60, and/or an end-systolic dimension =4.0 or 4.5 cm) are indications for surgery.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For Comments and archives…

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Child sexual abuse in China: A meta-analysis of 27 studies

Objective: To examine whether Chinese studies of child sexual abuse (CSA) in the general population show lower prevalence rates than other international studies, and whether certain features of these studies may help to account for variation in estimates.

Methods: A meta-analysis and meta-regression were conducted on 27 studies found in the English and Chinese language peer reviewed journals that involved general populations of students or residents, estimated CSA prior to age 18, and specified rates for males or females individually.

RESULTS: Estimates for Chinese females were lower than the international composites. For total CSA for females, the Chinese pooled estimate was 15.3% (95% CI=12.6-18.0) based on the meta-analysis of 24 studies, lower than the international estimate (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011) but not significantly. For contact CSA for females, the pooled estimate was 9.5% (95% CI=7.5-11.5), based on 16 studies, significantly lower than the international prevalence. For penetrative CSA for females, the pooled estimate was 1% (95% CI=0.7-1.3), based on 15 studies, significantly lower than the international estimate of 15.1%. Chinese men reported significantly less penetrative CSA but significantly more total CSA than international estimates; while contact CSA reported by Chinese and international males appeared to be roughly equivalent. Chinese CSA prevalence estimates were lower in studies from urban areas and non-mainland areas (Hong Kong and Taiwan), and in surveys with larger and probability samples, multiple sites, face-to-face interview method and when using less widely used instruments.

CONCLUSIONS: The findings to date justify further research into possible cultural and sociological reasons for lower risk of contact and penetrative sexual abuse of girls and less penetrative abuse of boys in China. Future research should examine sociological explanations, including patterns of supervision, sexual socialization and attitudes related to male sexual prowess.

(Source: Ji K, Finkelhor D, Dunne M. Child Abuse Negl. 2013 Apr 30)

For Comments and archives…

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Early results promising for new TAVI valve

An investigational transcatheter aortic valve implantation (TAVI) device met its goal for performance and substantially improved aortic regurgitation, but resulted in a high rate of pacemaker implantation, preliminary results of a single-arm trial showed. (Source: Medpage Today)

Foot problems run in families

An article published online May 20 in Arthritis Care & Research reports that bunions (hallux valgus) and toe abnormalities such as hammer or claw toes become more prevalent with age but are strongly influenced by heredity. (Source: Medscape)

Balloon proves mettle for stent restenosis

A paclitaxel-eluting balloon worked just as well as a paclitaxel-eluting stent for treating drug-eluting stent (DES) restenosis, a Chinese trial showed. (Source: Medpage Today)

Elective labor induction may soon be medical history

Policies restricting nonmedically indicated labor inductions are now in place in the majority of hospitals in the United States, and early signs are that they have the desired effect, according to several new studies. (Source: Medscape)

Renal denervation safe in real-world setting

Out in everyday practice, renal denervation with the Symplicity device safely lowers blood pressure in patients with hypertension, preliminary results from the Global SYMPLICITY registry showed. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Natural Fast Food is Good for Health http://bit.ly/10uxvfk #Health

@DrKKAggarwal: Everything perceived as outside is sensations feelings images thoughts within you & "you" has no location in space/time

    Spiritual Update

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

Can a mantra or sound be used as a medicine?

The answer is yes. The difference between a Mantra and any sound is that the Mantra is an energized sound with medicinal values. There are many aspects of Mantra as a sound:

  1. The type of sound matters. It is well known that chanting of vowel sounds produces interleukin 2 in the body which has the same action as that of aspirin and works like a natural painkiller.

For Comments and archives…

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How will the doctor examine my uterus?

There are many different ways for your doctor to look at your uterus. These include:

  • Vaginal ultrasound: A vaginal ultrasound utilizes a probe that is placed inside the vagina. The probe transmits sound waves that allow visualization of the organs in and around the pelvic cavity. The use of vaginal ultrasound helps the doctor see the wall and lining of your uterus.
  • Sonohysterogram (Saline Infusion Ultrasound): When the inside cavity of the uterus needs to be evaluated, your doctor may want to perform a saline infusion ultrasound. During this procedure, a small amount of sterile solution is placed into your uterus for a better look at the cavity.
  • Hysterosalpingogram: This procedure provides information about the fallopian tubes and uterine cavity. The doctor injects a special dye into your uterus and then performs an x–ray to visualize the path of the dye through the fallopian tubes. This test allows your doctor to determine if the fallopian tubes are open.
  • Hysteroscopy: This procedure is performed with a small telescope attached to a camera (called a hysteroscope) that lets the doctor look inside your uterus. Because the doctor has a direct view of your uterus, this procedure may provide the most accurate information.
    An Inspirational Story

The Real Pearl Necklace

Jenny was a bright-eyed, pretty five-year-old girl. One day when she and her mother were checking out at the grocery store, Jenny saw a plastic pearl necklace priced at $2.50.

How she wanted that necklace, and when she asked her mother if she would buy it for her, her mother said, “Well, it is a pretty necklace, but it costs an awful lot of money. I’ll tell you what. I’ll buy you the necklace, and when we get home we can make up a list of chore that you can do to pay for the necklace. And don’t forget that for your birthday Grandma just might give you a whole dollar bill, too. Okay?”

Jenny agreed, and her mother bought the pearl necklace for her. Jenny worked on her chores very hard every day, and sure enough, her grandma gave her a brand new dollar bill for her birthday. Soon Jenny had paid off the pearls.

How Jenny loved those pearls. She wore them everywhere-to kindergarten, bed and when she went out with her mother to run errands. The only time she didn’t wear them was in the shower; her mother had told her that they would turn her neck green.

Now Jenny had a very loving daddy. When Jenny went to bed, he would get up from his favorite chair every night and read Jenny her favorite story. One night when he finished the story, he said, “Jenny, do you love me?” “Oh yes, Daddy, you know I love you,” the little girl said.

“Well, then, give me your pearls.” “Oh! Daddy, not my pearls!” Jenny said. “But you can have Rosie, my favorite doll. Remember her? You gave her to me last year for my birthday. And you can have her tea party outfit, too. Okay?”

“Oh no, darling, that’s okay.” Her father brushed her cheek with a kiss. “Good night, little one.” A week later, her father once again asked Jenny after her story, “Do you love me?” “Oh yes, Daddy, you know I love you.”

“Well, then, give me your pearls.” Oh, Daddy, not my pearls! But you can have Ribbons, my toy horse. Do you remember her? She’s my favorite. Her hair is so soft, and you can play with it and braid it and everything. You can have Ribbons if you want her, Daddy,” the little girl said to her father.

“No, that’s okay,” her father said and brushed her cheek again with a kiss. “God bless you, little one. Sweet dreams.” Several days later, when Jenny’s father came in to read her a story, Jenny was sitting on her bed and her lip was trembling. “Here, Daddy,” she said, and held out her hand.

She opened it and her beloved pearl necklace was inside. She let it slip into her father’s hand. With one hand her father held the plastic pearls and with the other he pulled out of his pocket a blue velvet box. Inside of the box were real, genuine, beautiful pearls. He had them all along. He was waiting for Jenny to give up the cheap stuff so he could give her the real thing.

The same with our Heavenly Father, He is waiting for us to give up the cheap/fake things in our lives. Are you holding on to harmful relationships, habits, activities… which you have come so attached to that it seems impossible to let go? Sometimes it is so hard to see what is in the other hand but do believe one thing, God will never take away something without giving us something better.

For comments and archives

   Cardiology eMedinewS

Absorbable stents take spotlight at EuroPCR Read More

   Pedia News

Smartphone 'Addiction' may affect adolescent development Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Are pregnancy and lactation contraindications for IDRV?

Pregnancy and lactation are not contraindications for IDRV.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine was put on the herb, Butterbur.
Dr. Bad: It is a drug of choice for preventing migraine.
Dr. Good: Its benefits still remain unproven.
Lesson: Herbal therapies like the Butterbur and Feverfew have been evaluated for the treatment of migraine headaches. Of these, Feverfew has been the most widely studied. Some studies have found it to be effective for migraine prevention, although most experts agree that the benefits are still unproven. Neither treatment is recommended.

Make Sure

Situation: A patient of suspected MI died after receiving sublingual nitrate.
Reaction: Oh my God! Why was a history of Viagra drug intake not taken?
Lesson: Make sure to take a history of Viagra drug intake before giving nitrates, because the two drugs co–administered can cause fatal fall in blood pressure.

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  Quote of the Day (Dr GM Singh)

Friendship is a single soul dwelling in two bodies. Aristotle

    Mind Teaser

Read this…………………

An 8-month-old is admitted to the pediatric unit following a fall from his high chair. The child is awake, alert, and crying. Nurse Fatima should know that a brain injury is more severe in children because of:

a. Increased myelination
b. Intracranial hypotension
c. Cerebral hyperemia
d. A slightly thicker cranium

Yesterday’s Mind Teaser: A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys’ ability to remove a substance from the plasma in:

a. 1 minute
b. 30 minutes
c. 1 hour
d. 24 hours

Answer for Yesterday’s Mind Teaser: a. 1 minute

Correct answers received from: Dr Thakor Hitendrsinh G, Dr BB Gupta, Dr Pankaj Agarwal, Dr K Raju, Dr Arpan Gandhi, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen,
Dr KV Sarma, Daivadheenam, Dr Chandresh Jardosh.

Answer for 26th May Mind Teaser: d. Foul-smelling discharge from the penis

Correct answers received from: Dr Shashi Saini, Dr PC Das.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Three men were standing on a hill. The decided to throw their watches down the hill.

The first man threw his watch and it broke when it hit the bottom of the hill.

Then the second man did the same thing, and it also broke.

The third man threw his watch down the hill, but ran down the hill to catch it, so it didn’t break.

The other two men were very confused, so they asked how that was possible.

The third man told them, “Oh it wasn’t that difficult. My watch is 5 minutes slow.”

  Medicolegal Update

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

How will a doctor assess the severity of stab wounds by external examination?

The severity is based exclusively on the location and depth of penetration seen in autopsy.

  • The important medical considerations include the type of weapon used e.g. knife length, shape, straight or serrated, and manner of assault, whether the stabbing is overhand/underhand.
  • The gender of the assailant may have some importance, in that women tend to stab "overhand." Penetration tends to be deeper with the "underhand" thrust.
  • Stab wounds to the chest should always be considered dangerous and likely to cause death until proven otherwise.
  • Central stab wounds, below the clavicles and to either side of the breastbone means sternum, can result in penetration of the heart. Chest wounds can result in puncture and rupture of the lung or marked bleeding within the chest cavity causing hemothorax.
  • Stab wounds to the abdomen will often result in an exploratory laparotomy to rule out serious damage. Slow bleeding inside the abdomen is extremely difficult to diagnose, and should be considered a possibility in every case.
  • Stab wounds to the upper back can involve the lung or heart.
  • Stab wounds to the lower and middle back can involve the kidneys and ureters. Evaluation of stab wounds to the back that may have punctured the kidney will require intravenous pyelography for evaluation. The presence of blood in the urinalysis indicates injury to the kidney, bladder or ureter.
  • Examination for sensation, movement and pulses of the victim should be carefully done and documented in case of stab wounds to the hands/legs that do not lacerate nerves, blood vessels, or tendon structures.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management together with empirical treatment is unsuccessful or those who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe or the esophagus, a condition linked with persistent acidity. This was stated by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

He said that loss of appetite, loss of weight, difficulty in swallowing food, bleeding and signs of systemic illness suggest complicated disease.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food which makes the food pipe valve lax. Examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 52616 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Response
  1. Dear Sir, emedinews is very informative. Regards : Dr Shreya
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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