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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 …

30th October 2011, Sunday

Japanese encephalitis Update

  • Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus.
  • JEV is the most important cause of viral encephalitis.
  • About 50,000 cases of JE occur each year.
  • Fewer than 1 % of JEV infections results in symptomatic brain disease.
  • When brain is involved it is usually a very severe disease with a high case fatality rate and neurological sequelae in 30 to 50 % of survivors.
  • JE typically affects children <15 years of age
  • By early adulthood, majority of people develop protective immunity following natural exposure to JEV.
  • JE can affect individuals at any age.
  • JEV is transmitted involving mosquitoes and hosts like pigs and wading birds.
  • Humans are incidental and dead end hosts as they do not develop sufficiently high viremia to infect feeding mosquitoes.
  • The most common clinical presentation of JEV infection is acute encephalitis.
  • Milder forms of disease such as aseptic meningitis or non-specific febrile illness with headache also occur.
  • Fits (usually generalized tonic-clonic) are very common in children.
  • JE is diagnosed by detection of JEV-specific IgM antibody in CSF or serum.
  • IgM antibody in serum is suggestive of JE but could indicate asymptomatic infection or recent JE vaccination.
  • There is no specific antiviral treatment for JE.
  • Treatment consists of supportive care.
  • Precautions include personal protective measures to prevent mosquito bites.
  • For high risk setting, JE vaccine may further reduce the risk of infection
  • Mosquitoes of the Culex vishnui subgroup, particularly Cx. tritaeniorhynchus, are the major vectors of JEV.
  • Cx. tritaeniorhynchus commonly breeds in rice fields, marshes, and other shallow pools of water.
  • It is an evening and nighttime biting mosquito and mainly feeds outdoors.
    • Pigs and wading birds, such as herons and egrets, are the most important hosts.
    • Pigs are a key host as they develop high levels of viremia.
    • JEV infection in pigs is usually asymptomatic, but gestational infection can result in abortions and stillbirths.
    • Areas without pigs are usually free of disease.
    • The risk for JEV infection is highest in rural, agricultural areas of Asia.

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

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

Japanese encephalitis Update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011 – Harmony Interschool Health Festival

Purpose of this competition is not only to have a competition but to learn preventive strategies so that the children in future can become healthy adults. The festival was organized by Heart Care Foundation of India, Department of Health, Government of Delhi, NDMC, MCD and World Fellowship of Religions.

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


Dr KK’s Formula of 10 in cardiac arrest

Within 10 minutes of cardiac arrest for the next 10 minutes compress the center of the chest (as hard as one can) with a speed of 10 x10 = 100/minute and do not stop chest compressions for more than 10 seconds (for using a defibrillator to give an electric shock).

For comments and archives

Study says cellphone towers damaging biological makeup of birds, bees

PUNE: The rapid growth of the cellphone industry in India has fuelled haphazard building of base stations without prior planning or regulation, which is impacting the birds and bees biologically, an experts' committee has found. The panel has formulated guidelines to check their installation in the country. Nearly 800 million Indians have cellphones, making it the second largest cellphone-subscriber population in the world after China. A 13-member committee was set up by the union ministry of environment and forests in August 2010 to assess the possible impacts of growth of these base stations on wildlife. The members included scientist BC Choudhary of the Wildlife Institute of India, Sainudeen Pattazhy associate professor in S N College, Kerala and Asad Rahmani, director of Bombay Natural History Society. Rahmani was the chairman of the committee. (Source: TOI, Oct 27, 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)

Losing weight in middle age may lower heart disease risk

According to a study in the Archives of Internal Medicine, overweight adolescents who slim down in middle age may lower their risk" of heart disease.

For comments and archives

Airway change, loss before emphysema explain COPD

The narrowing and disappearance of small airways before the onset of emphysema accounts for the greater peripheral airway resistance seen in patients with chronic obstructive pulmonary disease (COPD), researchers found. (Source: Medpage Today)

For comments and archives

IDSA: Risk of muscle breakdown in HIV

The risk for rhabdomyolysis, the rapid destruction of skeletal muscle, is significantly elevated in HIV-infected patients, according to researchers here. (Source: Medpage Today)

For comments and archives

AACR-FCPR: Ovarian cancer more aggressive with age

Older women who developed ovarian cancer had a significantly greater likelihood of rapidly progressive, fatal disease, data from two large cohort studies showed. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: India would be aiming to wrap it up by beating the visitors in the one-off T20 International at the Eden Gardens on Saturday.

@DeepakChopra: Science & God http://bit.ly/uzMiiv

    Spiritual Update

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

The science behind Bhai Dooj

  1. Bhai Dooj is celebrated two days after Diwali.
  2. Like Raksha Bandhan it’s a day dedicated to the sacred love between a brother and sister.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

A Bit of Wisdom

During a trying time in my life I have received much comfort from the comments and the input of readers and I would like to submit a bit of wisdom of my own. It results from my life experiences thus far.

Do not look in books for instructions on how to live your life. By doing so you will only end up following someone else's road. Look only inside yourself. You must trust your own voice, think with your own mind, follow your own heart, and believe in your own dreams. Only you know what you need or what is good for you. You can only survive and succeed when you are true to yourself and not to the opinions of others.

Do not look at life through the eyes of someone else; do not end up second-guessing your own thoughts and feelings in the false believe that others are automatically wiser than you are. Trust yourself, listen to your heart, chart your own course, be your own North Star and be what the Great Spirit intended you to be - one of a kind.

For comments and archives

    Fitness Update

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

COPD therapy: Why is steroid treatment ineffective for COPD?

COPD leads to persistent inflammation of the airways and is typically managed with corticosteroids, a class of anti-inflammatory medication. However, corticosteroids do not improve survival nor alter the progression of COPD and may reduce lung symptoms as little as 20 per cent. COPD is a major public health problem for both the developed and the developing world, and is most often caused by cigarette smoking or exposure to pollutants from combustion.

Histone deacetylase 2 (HDAC2) is critical component in a chain of reactions that enable corticosteroids to reduce inflammation. However, HDAC2 is substantially reduced in the lung tissue of individuals with COPD. In the study, researchers found that S-nitrosylation causes HDAC2 dysfunction and leads to corticosteroid insensitivity in the alveolar macrophages of the lungs of individuals with COPD. S-nitrosylation of HDAC2 occurs from exposure to cigarette smoke, a primary cause of COPD. Furthermore, the research team found that treatment with sulforaphane restored HDAC2 activity and corticosteroid sensitivity. Previous studies by the research team showed sulforaphane activates the Nrf2 pathway (nuclear factor erythroid 2–related factor 2) and it is being tested in clinical trial for patients with COPD. “Restoring corticosteroid sensitivity in patients with COPD by targeting the Nrf2 pathway holds promise for effectively treating exacerbations,” said Professor Shyam Biswal of the Johns Hopkins School of Medicine.

For comments and archives

    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?

People who snore and have >5 episodes of stopped breathing per hour of sleep are four times more likely to have automobile accidents.

For comments and archives

    Malaria Update

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

What the National Drug Policy of India says

How to report cases of malaria?

Malaria is currently not a notifiable disease in India, but it important that private providers inform the Government malaria services about malaria cases seen every fortnight. Suitable formats for this can be obtained from district malaria officers or block medical officers. Whenever a private provider observes an increase in the number of suspected or confirmed malaria cases, this should be intimated urgently to local health authorities.

For comments and archives

    Medicine Update

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

When should glycogen storage disease be suspected clinically?

On history

  • Symptoms that can be attributed to sustained hypoglycemia – lethargy, sweating, seizures, failure to thrive
  • Developmental delay
  • Cardiomyopathy– repeated episodes of CHF
  • Muscle weakness and cramps, which increase on exercise
  • Delayed motor milestones
  • Prolonged neonatal jaundice

For comments and archives

    Legal Question of the Day

(Dr M C Gupta, Advocate)

Are there any rules/orders/judgments etc. which say that physiotherapists cannot use the suffix Dr. and cannot prescribe medicines?


A. Physiotherapists cannot use the prefix Dr. before their name as per the following:

  1. A reading of the Delhi Council for Physiotherapy and Occupational Therapy Act, 1997, reveals that there is nothing in the Act to imply that those registered under the Act may use the prefix “Dr.”
  2. In addition, the Chairman, Delhi Council for Physiotherapy and Occupational Therapy, has also stated that: “As per the Council’s Act there is no provision as of now allowing physiotherapists to use the title ‘Doctor’ but a discussion on the matter is currently on.” This can be seen at the link given below—
  3. I may state that I am not aware of any pending litigation in this regard as of now. In any case, a pending litigation does not alter the above picture unless the court has granted a stay in favour of the physiotherapists. That does not appear to be the case.
  4. On 25-11-2003, the Ministry of Health and Family Welfare, Government of India issued an order wherein it was clarified who all can use the prefix “Dr.” before their names. This letter does not so permit physiotherapists. The permission is available only for modern medicine and the already recognized traditional systems of medicines, viz. Ayurveda, Siddha, Unani, Homeopathy and Yoga & Naturopathy. The full text of the letter can be seen at

    It may be stated that the GOI order dated 25-11-2003 was issued pursuant to the writ in the Delhi High Court bearing no. CWP 4015/1996.
  5. On 25th August, 2008, the Executive Committee of the MCI issued a letter No.MCI-5(3)/2008-Med./ dated 25th August, 2008. This letter referred to the Indian Medical Degrees Act, 1916, and stated that “wherever any person found to be using the title of ‘Doctor’ as a prefix when such a person is holding a qualification in physiotherapy but not possessing any recognized medical qualification, he would be violating the provisions of Act of 1916 and as such he would expose himself for necessary action by filing or requiring the filing of a complaint in accordance with Section 7 of the 1916 Act for violation of Sections 6 and 6A of the extent applicable.”

    The full text of the letter can be seen at
  6. 6. On 9-9-2009, the Government of Tamil Nadu Health and Family Welfare (Z1) Department issued an Annexure dated 9-9-2009 to the G.O. (Ms) No.338 Health and Family Welfare Department, dated 16.10.2008, wherein it was stated that in reference to Tamil Nadu State Council for Physiotherapy:

    "Physiotherapist means a person who possesses recognized physiotherapy education and whose name has been entered in the Register of Physiotherapy Council. He shall not use “Dr.” before his name and prescribe drugs”.
    This may be viewed at--

B. Physiotherapists cannot prescribe medicines as decided by the HC and the SC. Please refer Refer:
Sri Sarjoo Prasad and Ors. vs The State Of Bihar And Ors., Patna High Court, 21 February, 2003 2003 (51) BLJR 686

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Insulin & C–peptide

C–peptide measurements can be used in conjunction with insulin and glucose levels to help diagnose the cause of documented hypoglycemia and to monitor its treatment. C–peptide levels are measured:

  • In newly diagnosed type 1 diabetes, as part of an evaluation of residual beta cell function.
  • In type 2 diabetes, to monitor the status of beta cells and insulin production over time and to determine if/when insulin injections may be required.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A middle–aged patient was found to have central obesity.
Dr Bad: It is normal.
Dr Good: Rule out diabetes.
Lesson: As per results of a prospective cohort study (1989–2007) of 4,193 men and women 65 years of age and older in the Cardiovascular Health Study, among older adults, overall and central adiposity and weight gain during middle age and after the age of 65 years were associated with risk of diabetes.

For comments and archives

Make Sure

Situation: An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin (macrolide) 500 mg twice-daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

For comments and archives

    Quote of the Day

(Dr GM Singh)

When you find a dream inside your heart Don’t ever let it go because Dreams r the seeds from which beautiful tomorrows grow.


The bigger they are the harder they fall: While the bigger and stronger opponent might be a lot more difficult to beat, when you do they suffer a much bigger loss.

    Mind Teaser

Read this…………………

Treatment for bleeding duodenal diverticulum is

a) Diverticulectomy
b) Diverticulopexy
c) Diverticulization
d) Subtotal diverticulectomy

Yesterday’s Mind Teaser: The most common extraintestinal manifestation of Crohn's disease of small intestine is:
a) Ankylosing spondylitis
b) Erythema nodosum
c) Iritis
d) Ureteral obstruction

Answer for Yesterday’s Mind Teaser: b) Erythema nodosum

Correct answers received from: Dr Sukla Das, Dr PC Das, Dr Ragavan Moudgalya, YJ. Vasavada,
Dr F Johar, Dr Sathiyamoorthy Veerasamy, Dr Jainendra Upadhyay, Dr Thakor Hitendrasinh G, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Ajay Gandhi, Anil Bairaria, Dr NeelamNath,
Dr Krishna Kavita, Dinesh Yadav.

Answer for 28th October Mind Teaser: a) Its infectivity is highest in developed world.
Correct answers received from: Dr K Raju, Dr Thakor Hitendrasinh G. Muthumperumal Thirumalpillai,
Dr Chandresh Jardosh, Dr Ajay Gandhi, Anil Bairaria.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr GM Singh)


The old man had died. A wonderful funeral was in progress and the country preacher talked at length of the good traits of the deceased, what an honest man he was, and what a loving husband and kind father he was.

Finally, the widow leaned over and whispered to one of her children, "Go up there and take a look in the coffin and see if that's your pa."

    Medicolegal Update

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

Forensic opinion in Close and contact wounds of fire arms missile

  • When a firearm is discharged very close to or in contact with the skin surface, the gases produced by the explosion pass into the tissues along with the bullet and cause considerable laceration of the skin and subcutaneous tissues. Under these conditions the bullet entrance wound has a ragged appearance, especially over the skull where it may be stellate in appearance.
  • At close range there is usually some blackening and tattooing of the skin around the bullet entrance wound, while the hair in the region of the wound may be singed, and there may be some skin burning and abrasion in relation to the hot gases. In contact wounds, the discharge passes into the tissues through the bullet entrance opening and powder deposits as well as blackening may be observed I the depths of the wound.
  • When a firearm is discharged at a range of about 15 cm, the lacerating and burning effects of the gases are usually lost owing to the dispersion and cooling of the gases before they reach the skin. In these conditions the bullet entrance wound is circular in shape and is surrounded by a narrow zone of skin abrasion. Blackening of the skin is sometimes seen, while tattooing is invariably found at this range.
  • Beyond a range of 15 cm, all traces of blackening usually disappear, while the bullet entrance is opening remains circular in shape.
  • Powder grain deposits may still be present, and are usually seen up to ranges of about 40-60 cm, but the limit within which powder grain deposits can occur varies with different weapons and different cartridges.

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)

B12 deficiency can present with recent memory loss

If you keep forgetting things, then instead of worrying that you are moving towards dementia get your vitamin B12 levels done said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

Animal products (meat and dairy products) provide the only dietary source of B12 (cobalamin or Cbl) for humans. Strict vegans avoid all animal products, and are at risk of developing nutritional Cbl deficiency.

The usual western diet contains 5 to 7 micrograms of cobalamin per day, while the minimum daily requirement is 6 to 9 micrograms per day. Total body stores of Cbl are 2 to 5 milligrams and one-half of which is in the liver. It takes years to develop vitamin B12 deficiency after absorption of dietary B12 ceases.

There is a link between infection with Helicobacter pylori (as seen in peptic ulcer) and low serum B12 levels.

Mild and usually subclinical cobalamin deficiency can also occur in 24% of the elderly. About 10 to 30 percent of patients taking metformin (diabetics, obesity, polycystic ovarian disease) have impaired Cbl absorption and lower B12 levels, which can be reversed with supplemental oral calcium. Prolonged use of omeprazole (given for acidity) can result in Cbl deficiency.

Women who are only moderate vegetarians may become Cbl deficient during pregnancy and lactation; their infants may also be Cbl deficient.

For comments and archives

    Readers Responses
  1. Dr Aggarwal, Happy Diwali. You are doing yeoman job of educating us through emedinews. Keep it up. Regards. Dr U K Ghosh
    Forthcoming Events

A Heart Care Foundation of India Initiative

Camp Name: Ask Dr KK
Heart Checkup Camp
Organizer: Maheshwari Club in association with Heart Care Foundation of India and World Fellowship of Religions.
Sunday, 30th October, 2011
Venue: Aggarwal Dharamshala, Kalkaji Extention, behind Punj Factory near Govind Puri Metro Station
Time: 9 Am to 1 Noon

The camp includes consultation with Dr K K Aggarwal and team.
Facilities available: ECG, BP, Height, Weight, Abdominal Circumference, Neck circumference and Colour Doppler Echo screening where necessary. Special Yoga Classes
On Spot Registration

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

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

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  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