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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; 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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

2nd December 2012, Sunday

Shiela Dikshit Gets Angioplasty

Delhi Chief Minister, Smt. Shiela Dikshit recently got her second angioplasty done. Sometimes in the year 2000, she underwent a bypass surgery; in 2006 she underwent her first angioplasty and in 2012 second angioplasty. In a matter of 13 years, she underwent three interventional procedures. This was the case also with our Prime Minister Dr. Manmohan Singh who over a period of time too underwent two bypass surgeries and two angioplasty procedures.

If we look at two celebrities of the country, the interventional procedure lasted in them for 4-5 years average. It is a fact that arterial bypass graft surgery lasts much longer than bypass surgery involving venous graft. Unfortunately, most centers do not do total arterial surgery. The life of a venous graft on an average is 4-5 years and that of arterial graft is 10-15 years.

Angioplasty also may not last more than 5-6 years. Apart from interventions, the native disease is also bound to progress over a period of time and new lesions are bound to appear over a period of time.

I personally feel that lifestyle intervention has a great role to play before and after an intervention. In a survey of 100 patients done by Heart Care Foundation of India, we found that over 80% of the people were not adhering to the cardiac lifestyle by the time they complete the second year of their intervention. Most of them were adhering to the special precautions in the first year with total precautions in the first six months only. By the start of three year, their dietary habits, smoking and drinking patterns had returned to their baseline behavioral patterns.

In a person who requires an intervention at the age of 50, if we have to plan next 30-40 years of his existence, I normally suggest the following:

  • Aggressive and optimal lifestyle management to postpone the first intervention by 4-5 years unless the person has an acute coronary syndrome or unstable cardiac status.
  • Choosing the first intervention as angioplasty with stents (provided he can afford) to get additional 5-6 years of symptom-free life.
  • Repeat angioplasty, if possible or the first bypass surgery if angioplasty is not feasible. This will give another 5-7 years.
  • Once the symptoms reappear, one can go for repeat angioplasty of the graft or of the native vessel. This can be repeated one more time.
  • Finally, a repeat bypass can be done which can be followed by repeat angioplasty of graft vessel if possible.

With this it will be easy for a person of 50 to live up to 80-90 years without any cardiac risk and symptom. Of course, all this costs a lot of money.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Evaluation of constipation should begin with a detailed history and physical examination that includes a rectal examination.

For Comments and archives…

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Cigarettes Hurt women’s Heart More than Men's

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal at World AIDS Day Function at India Islamic Cultural Centre organised by Times of India group and Delhi State AIDS Control Society

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

World AIDS Day: Maharashtra in bottom half of HIV report card

MUMBAI: HIV/AIDS claimed 60,000 fewer lives in 2010-11 than two years ago and the national average showed a healthy decline in the percentage of people testing positive for the virus, but Maharashtra maintained its position as a high-risk state ranking among the bottom five on several counts. The new HIV estimates released by Union health minister Ghulam Nabi Azad on the eve of World AIDS Day show Maharashtra remains a hotbed for HIV infection among high-risk groups and the prevalence rate is much higher than the national average. According to the recently concluded HIV Sentinel Surveillance 2010-11, national prevalence among adults (15-49 years) dipped to 0.27% but the positivity in the state hovered around 0.42%. In fact, Maharashtra, with six other states, accounted for 31% new infections in the two years since the previous study. Agencies working for HIV prevention in the state attributed the high prevalence to migration. Project director of Maharashtra State AIDS Control Society (MSACS) Ramesh Devkar said: "While more people are approaching care centres, migration is one of the main causes why we continue to remain a hotbed." The state has come off as the worst for HIV among female sex workers (FSW) with prevalence at 6.89% against a national average of 2.67%. Devkar pointed out that prevalence was around 11% two years ago, arguing that the state is improving. His biggest worry remains HIV prevalence among men having sex with men (MSM) and intravenous drug users (IDU). The national average for MSM is 4.43% but it's almost a steep 10% in the state. Experts say Mumbai plays a huge role. Though there is no official confirmation, the prevalence of HIV among MSM in the city is believed to be above 12%. Worse, among transgenders, the prevalence stands at an astounding 18.80%. For intravenous drug users, the state average for HIV/AIDS prevalence stood at 14.17%, double the national average of 7.14%. Overall, reduction in HIV cases among IDUs at the national level has not been significant. It has dipped from 7.23% in 2007 to 7.14% in 2011. In the HSS study, Mumbai surprisingly emerged as one of the areas with high prevalence of HIV among truckers. While Gujarat's Kutch topped the list with 8.1% prevalence, Mumbai appeared among the hotspots with an average of 1.2%, along with Nagpur 2% from the state. The total number of people living with HIV/AIDS (PLHIV) in India is estimated at 21 lakh last year with the state accounting for over 4.20 lakh cases. Around 1,243 people have succumbed to AIDS in the state this year till October. (Source: TOI, Dec 1, 2012)

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

In end-stage renal disease, mitral annular and aortic valve calcification occurs in 10-50% and 25-55% of patients, respectively. The occurrence of tricuspid and pulmonic valvular calcification is rare.

(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

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Faulty thyroid hikes Afib risk

Even mild disruptions in thyroid function may increase the risk of atrial fibrillation, Danish researchers found. (Source: Medpage Today)

Visceral fat may raise men's fracture risk

Having more visceral fat -- the kind that collects around the internal organs of the abdomen, rather than just beneath the skin -- appears to put men at a higher risk of bone loss, researchers said at the Radiological Society of North America meeting.(Source: Medpage Today)

Injectable used in heart studies recalled

The FDA has issued a class I recall on prefilled syringes of iopamidol injection used in angiography because of the presence of particulate matter. Nine lots of Isovue Pre-Filled Power Injector Syringes may have visible particles in them, which may cause serious adverse events, including stroke, if the product is used during an arterial injection, the agency said in a statement. The recall includes Isovue 370, 370 FLS2, 300, and 300 FLS2 units with lot numbers 9L40746, 0A43705, 0C57509, 9K37791, 0C57521, 0E62913, 9K34572, 0A43282, and 0C56283. (Source: Medpage Today)

Heart risk from preeclampsia tied to number of kids

The greater risk of subsequent cardiovascular death among women with preeclamptic pregnancies appears to be concentrated among those who only have one child during their lifetime, researchers found. Overall, preeclampsia during a first pregnancy was associated with an elevated cardiovascular mortality risk that was stronger for preterm preeclampsia (HR 3.7, 95% CI 2.7 to 4.8) than for term preeclampsia (HR 1.6, 95% CI 1.4 to 2.0), according to Rolv Skjaerven, PhD, of the University of Bergen in Norway, and colleagues. Those risks, however, were higher for women who did not have any more children -- particularly for those with preterm preeclampsia -- and lower for those who had additional children, the researchers reported online in BMJ. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: I uploaded a @YouTube video http://youtu.be/3B_s2BakQAI?a Sushil Shinde Endorses CPR 10

@DeepakChopra: Modern age has a lot to thank to Newton, but we have also moved far beyond his discoveries. http://tinyurl.com/ab5rp5q

    Spiritual Update

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

Why is a period of six months to one year given to reconcile by the court before getting a divorce?

The principle of counseling comes from Bhagavad Gita where Arjuna, when he was confused whether to fight or not, Lord Krishna his counselor gave him 18 sessions. In the first session, he only listened to him. In the second session, he counseled him in great details. From 3rd to 17th session, he gave reasoning for each and every counseling aspect, frightened him and yet consoled him and lastly in the 18th session, he revised his counseling advices.

For comments and archives

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

If an abnormally shaped sperm fertilizes the egg, does that mean that my child will have genetic abnormalities?

There's no scientific link between the shape of a sperm and its chromosomal content. Once the sperm penetrates the egg, fertilization has a good chance of taking place. However, there may be some male offspring who will inherit the same type of morphology abnormalities.

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

False Negatives

Positive DAT - Rh HDN - blocking D antigen sites - elute and retype

    An Inspirational Story (Dr GM Singh)

Good news or Bad news

Robert De Vincenzo, the great Argentine golfer, once won a tournament and, after receiving the check and smiling for the cameras, he went to the clubhouse and prepared to leave. Some time later, he walked alone to his car in the parking lot and was approached by a young woman. She congratulated him on his victory and then told him that her child was seriously ill and near death. She did not know how she could pay the doctor’s bills and hospital expenses.

De Vincenzo was touched by her story, and he took out a pen and endorsed his winning check for payment to the woman. "Make some good days for the baby," he said as he pressed the check into her hand.

The next week he was having lunch in a country club when a Professional Golf Association official came to his table. "Some of the boys in the parking lot last week told me you met a young woman there after you won that tournament." De Vincenzo nodded. "Well," said the official, "I have news for you. She’s a phony. She has no sick baby. She’s not even married. She fleeced you, my friend."

"You mean there is no baby who is dying?" said De Vincenzo.

"That’s right," said the official. "That’s the best good news I’ve heard all week." De Vincenzo said.

Moral: Good news or bad news? It depends on how you see things. You can be bitter after cheated. Or you can choose to move on with your life.......

For comments and archives

    Cardiology eMedinewS

Diabetes remission after gastric bypass: One third relapse Read More

Glucosamine, chondroitin, fish oil may reduce inflammation Read More

    Pediatric eMedinewS

CDC: Don't use infant sleep positioners unless prescribed Read More

Eczema, egg allergy in infants may predict peanut allergy Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 45–year–old came with first onset diabetes.
Dr Bad: Start pioglitazone.
Dr Good: Start metformin.
Lesson: In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (Diabetes Care 2009;32:193).

Make Sure

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

    Quote of the Day (Dr GM Singh)

Confidence is courage at ease. Daniel Maher

    Legal Question of the Day (Dr MC Gupta)

Q. I work as a paediatrician in a semi-government organization in Delhi. Due to extreme shortage of staff, the house keeping female staff in the Obs- Gyne ward helps in daily nursing and birthing. The problem is not new but what is the solution?


  • Let us first define the problem. The solution can come only when there is a well defined problem.
  • “The problem from the doctor’s perspective”—Something goes wrong. A consumer of medical service alleges negligence and files complaints with the consumer court, police and medical council, alleging that the doctor did not attend properly and allowed the delivery to be conducted by an unqualified person. It is possible that each complaint may result in an adverse decision. The doctor may be removed from service if not permanent or departmental inquiry may be ordered against her as per rules and she may be punished.

    SOLUTION—She should send an official communication to the medical superintendent, through her HOD, under acknowledgement, informing about the state of affairs and need for sufficient staff and the likelihood of avoidable complications in future if necessary measures are taken in time.

    She should preserve the copy with acknowledgement. This may help or save her in future.
  • “The problem from the administrator’s perspective”—A consumer complaint decided in favour of the complainant will mean that the compensation is paid by the hospital, not the doctor concerned.

    SOLUTION—The hospital administrator should take the following actions:
    • He should write to the owner/government etc. to provide more staff.
    • He should arrange for necessary training of the untrained staff in a well documented manner, including course curriculum; evaluation method and results; certificate of proficiency to those who pass. Such trained persons should be used not in a hush-hush manner but officially, including their names in the medical records as appropriate. They may even be given documented incentives for such services. The administrator should keep the higher authorities in the loop regarding this.

      The above arrangements will be helpful.
    Mind Teaser

Read this…………………

A client is admitted to the hospital with benign prostatic hyperplasia, the nurse most relevant assessment would be:

a. Flank pain radiating in the groin
b. Distention of the lower abdomen
c. Perineal edema
d. Urethral discharge

Yesterday’s Mind Teaser: The key factor in accurately assessing how body image changes will be dealt with by the client is the:

A. Extent of body change present
B. Suddenness of the change
C. Obviousness of the change
D. Client’s perception of the change

Answer for Yesterday’s Mind Teaser: D) Client’s perception of the change

Correct answers received from: Dr Kanta Jain, Dr (Maj. Gen.) Anil Bairaria, Dr Thakor Hitendrsinh G, Dr Pankaj Agarwal, Dr Chandresh Jardosh,
Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Avtar Krishan.

Answer for 30th November Mind Teaser: D. “Does it help you to joke about your illness?”

Correct answers received from: Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

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   Laugh a While (Dr GM Singh)

A man was chosen for jury duty who really wanted to be dismissed from serving. He tried every excuse he could think of but none of them worked. On the day of the trial, he decided to give it one more shot. As the trial was about to begin, he asked if he could approach the bench.

"Your Honor," he said, "I must be excused from this trial because I am prejudiced against the defendant. I took one look at the man in the blue suit with those beady eyes and that dishonest face and I said 'He's a crook! He's guilty!' So, your Honor, I cannot possibly stay on this jury!"

With a tired annoyance the judge replied, "Get back in the jury box, you fool. That man is the defendant's lawyer."

    Medicolegal Update

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

What is Sec 312 of the IPC?

Criminal and legal Abortions

Sec 312 of the IPC, 1860 under the heading "causing miscarriage" says that whoever voluntarily causes a woman with child to miscarry, shall, if such miscarriage be not caused in good faith for saving the life of the woman, be punished with imprisonment of either description of a term which may extend to three years, or with fine, or with both; and, if the woman be quick with the child, shall be punished with imprisonment of either description of a term which may extend to seven years or shall also be liable to fine. Explanation to this section: a woman who causes herself to miscarry, is also punishable thereunder.

  • In Dr. Akhil Kumar v. State of M.P., 1992 LJ 2029(MP), a woman living separately from her husband for 3 to 4 years conceived as a result of illicit intercourse with her distant cousin. When her pregnancy was of 24 weeks she approached a medical practitioner who pushed Menstrogen Forte injection into her which caused her death. The literature of Menstrogen Forte clearly stated that the effect of such injection could be miscarriage. The plea of the accused physician that he had pushed that injection to determine if she was pregnant was not believed because the six month old pregnancy was writ large on her abdomen discernible from outside and the doctor was convicted for attempt to cause miscarriage.
  • The deceased mother of four children, having become pregnant was taken by her son–in–law to a quack for abortion. She was later found dead and was buried. The dead body was exhumed after about 12 days and the quack was prosecuted under Sec. 314 and convicted thereunder on circumstantial evidence. (In Maideen Sab v. State of Karnataka, 1993 Cri LJ 1430 (Kar)

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

85 drugs can interact with grapefruit (Chakotra)

There are now more than 85 drugs that may interact with grapefruit. The list includes statins (atorvastatin, lovastatin, and simvastatin), some antibiotics, cancer drugs, and heart drugs. The elderly are most at risk, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India, quoting a study in Canadian Medical Association Journal.

Furanocoumarins in grapefruit blocks an enzyme that normally breaks down certain medications in the body. When it is left unchecked, medication levels can grow toxic in the body.

Other citrus fruits such as Seville oranges, limes, and pomelos also contain furanocoumarins.

The interaction can occur even if grapefruit is eaten many hours before taking the medication. Simvastatin, when taken with about a 7-ounce glass of grapefruit juice once a day for three days, produced a 330% greater concentration of the drug compared to taking it with water. This can cause life-threatening muscle damage.

    Readers Responses
  1. Dear Sir, You and your team is doing wonderful work. Regards: Dr TP Sharma
    Forthcoming Events

Pushpanjali Crosslay Hospital, is organizing PCCON-2012 (4th Annual Conference) in association with IMA East Delhi Branch and IMA West Ghaziabad Branch on 1st & 2nd Dec, 2012 at Hotel Country Inn, Sahibabad, Ghaziabad.

PC CON-2012” will be a multi-specialty conference covering a wide range of scientific sessions by eminent national and international speakers presenting the latest developments in the field of medical science.

“PC CON-2012” is the 4th Annual conference and more than 1000 delegates from all over the country are expected to attend.

Dr Gaurav Aggarwal, Organizing Secretary

Dr. N.P. Singh, Organizing Co-Chairman

Dr. Ganesh K. Mani, Organizing Chairman, Director & Sr. Consultant, Cardiovascular Surgeon

Encl: Brochure and scientific programme

4th eMedinews Revisiting 2012

(a day long single hall medical conference on 2012 happenings, followed by doctors of the year 2012 awards)

Sunday 20th January 2013, Maulana Azad Medical College Auditorium

Dilli Gate Delhi


Dr KK Aggarwal
Padmashri and Dr B C ROY National Awardee President

Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman

Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

4th eMedinewS Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Register at: www.emedinews.in/


4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

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

2. eMedinewS audio PPT (This may take a few minutes to download)

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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  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

    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, Dr Usha K Baveja