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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 …

3rd November 2011, Thursday

Dengue patients do not die of platelet deficiency but of intravascular leakage

As per international guidelines, unless the platelet count is less than 2% of base line levels AND there is spontaneous active bleeding, no platelet transfusion is required.

The cause of death in dengue is capillary leakage causing blood deficiency in vascular department, leading to multiorgan failure. At the first instance of plasma leakage from intravascular compartment to extravascular compartment, one needs to give 20 ml per kg body weight per hour of fluid replacement to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Leakage normally occurs after the fever is over.

Giving unnecessary platelet transfusion to the patient can harm the individual.

I have created a Formula of 20 for the family doctors to decide about admission of a case of dengue.

  • There is a rise in pulse by 20.
  • There is a fall in the upper (systolic) blood pressure by 20 mmHg.
  • The pulse pressure (difference between upper and lower blood pressure) is lower than 20.
  • The hematocrit (thickness of blood) increases by 20%.
  • Platelet count is less than 20,000.
  • There are more than 20 petechiae (bleeding spots) in the tourniquet test in one square inch area.

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

Dengue patients do not die of platelet
deficiency but of intravascular leakage

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011-
Inagural Function

The Inagural Function of the 18th MTNL Perfect Health Mela was organised at Sirifort Auditorium, Khel Gaon Road. Invited Guests of Honor and Special Guests on the Dais.

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


India facing heavy burden of neglected tropical diseases

Even as the world welcomed the seven billionth member of the global population this week, medical researchers warned that rapid–growth economies such as India’s still had a high proportion of morbidity with more than 290 million Indians suffering from Neglected Tropical Diseases (NTDs). In an article on A Disproportionate Burden of NTDs found in India and South Asia, tropical diseases scientists said that although India and South Asia had made significant economic progress, NTDs continued to perpetuate a cycle of poverty among its most disadvantaged populations. These NTDs include visceral leishmaniasis, also known as "kala–azar," lymphatic filariasis, which causes elephantiasis, leprosy, dengue fever, rabies and soil transmitted helminth. Speaking to The Hindu Peter Hotez, an author of the report and President of the Sabin Vaccine Institute in the United States, highlighted the strong link between NTDs and poverty, noting that many cases of NTDs had even occurred in the U.S. wherever poverty had been found. (Source: http://www.thehindu.com/news/national/article2587921.ece, November 1, 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

Risk factors for progression of glaucoma confirmed

Patients with glaucoma and elevated intraocular pressure (IOP) and splinter–type disc hemorrhage are more apt to experience progressive worsening of their condition. The confirmation of these risk factors could be valuable in designing interventions to help reduce progression of glaucoma in these patients, Spanish researchers announced here at the American Academy for Ophthalmology (AAO) 2011 Annual Meeting. (Source: Medscape Medical News)

For comments and archives

Altitude sickness worst in northern India

A region of northern India has been called the world’s worst place for altitude sickness, and scientists say nobody knows exactly why. Ladakh, a high–altitude desert on India’s northern border with China and Tibet, has become a popular destination for adventure travelers in the last decade who come to experience its remote culture and extraordinary beauty, Britain’s The Independent reported Monday. In a large study of visitors to mountainous regions around the world assessed for their vulnerability to altitude sickness, Ladakh was found to be the biggest threat. "When adjusted for all other risk factors, especially rate of ascent, one location –– Ladakh –– remained associated with a higher risk of severe high–altitude illness," study leader Jean–Paul Richalet, professor of physiology at the University of Paris North, said. Scientists said they were unable to discover why the particular area should present such a threat. (Source: http://www.upi.com/Science_News/2011/10/31/Altitude-sickness–worst-in–northern-India/UPI–49141320079649/, Oct 31, 2011)

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Alcohol link to breast cancer reaffirmed

Breast cancer risk increased modestly but significantly in women who reported a history of moderate alcohol consumption, investigators reported, confirming results of previous studies. Women who averaged three to six drinks a week had a 15% higher risk of invasive breast cancer compared with nondrinkers. The excess risk increased to 50% in women who averaged more than 30 drinks a week. (Source: Medpage Today)

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    Twitter of the Day

@DrKKAggarwal: #IJMD Improving oral health in the rural children is still a dream come true in a developing country like India… fb.me/13GuEQQJu

@DeepakChopra: Growth is the willingness to let reality be new every moment.

    Spiritual Update

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

The Science behind Ritam Bhara Pragya

The word for "routine" in Sanskrit, the language of the Vedas, is "ritam." Another translation of "ritam" is "rhythm." Most people think of "routine" as dull and boring. But "rhythm", means music! Rhythm has a tempo, a beat, a pulse and is alive.

For comments and archives

    An Inspirational Story

(Mr Vivek)

Story of two mice

Two mice fell into a bowl of cream. One of the mice after struggling for some time gave up and drowned in the cream. The second mouse kept flapping trying to get out. Soon the cream with his churning turned into butter and became thick enough for him to escape.

The choice is with us.

For comments and archives

    Fitness Update

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

12 Indian foods that cut fat

Curry leaves

Incorporating curry leaves into your daily diet can help you lose weight. These leaves flush out fat and toxins, reducing fat deposits that are stored in the body, as well as reducing bad cholesterol levels. If you are overweight, incorporate eight to 10 curry leaves into your diet daily. Chop them finely and mix them into a drink, or sprinkle them over a meal.

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    Healthy Driving

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

Commercial vehicle drivers should be completely medically fit

The medical fitness of a driver should include clinical examination, blood test and special tests like grip test, reach test and get and go test. To be a fit driver, a person should be able to demonstrate 35 rounds of strength in the hand on a grip strength dynamometer. Over one–third of accidents occur because the driver is not medically fit.

For comments and archives

    Medicine Update

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

How is a case of Hepatitis C diagnosed?

  • A screening antibody test such as an Enzyme immunoassay (EIA) or other immunoassay is initially performed and RT–PCR for RNA is used to confirm active infection. In HIV+ patients with a low CD4 count (<200 cells/mm3), the EIA may occasionally be negative and an RT–PCR may be needed for definitive diagnosis.
  • An antibody test may not become positive for three or more months after acute HCV infection but a test for HCV–RNA will be positive after only two weeks.
  • Chronic infection is confirmed if an HCV–RNA assay is positive six months after the first positive test. Patients with low–level viremia may require HCV–RNA levels testing on two or more occasions to confirm infection.
  • All patients being considered for therapy should have a viral RNA test to confirm viremia and be genotyped. A positive antibody test with persistently negative RNA test indicates resolved infection.

For comments and archives

    Legal Question of the Day

(Dr M C Gupta, Advocate)

I am a physiotherapist and have the following questions:

  1. In what way has Physiotherapy breached any rules or regulations of MCI Acts, or taken the role of a Modern medicine practitioner?
  2. Has any PT claimed the right to prescribe medicines to patients?
  3. Which legal document or court judgment proves that physiotherapy is an aid to modern medicine and has to be at a certain level in the medical hierarchy?
  4. How can anybody who is not trained in physiotherapy prescribe a physio–therapeutic treatment plan for a patient?


  1. Your first query stands answered by quoting para 2 of the following judgment–– Sri Sarjoo Prasad and Ors. vs The State Of Bihar And Ors., Patna High Court, 21 February, 2003 (51) BLJR 686 http://www.indiankanoon.org/doc/1012912/

    "2. The above mentioned SLP had arisen from the order dated 9–10–1998 on an interlocutory application (IA No. 8296/97) in CWJC No. 8444 of 1997. The writ Petition was filed as a public interest litigation highlighting the mismanagement in the Patna Medical College & Hospital, a premier teaching Hospital in the State of Bihar. The said interlocutory application related to Vikalang Bhawan, which was then part and parcel of the Patna Medical College & Hospital. It was inter alia, alleged that the para medical staff posted there had been prescribing allopathic medicines to patients, describing themselves as ‘Doctors’. Notice was issued to the persons concerned, namely, Shri Sarjoo Prasad and others. They did not deny that they had signed OPD slips, issued prescriptions and prescribed allopathic medicines. They also did not deny describing themselves as Doctors in the OPD slips or the prescriptions. They took the stand that being certificate holders in Occupational Therapy – involving study of subject similar to the study for the MBBS degree, they were eligible to prescribe allopathic medicines. In view of the decision of the Supreme Court in Medical Council of India v. State of Rajasthan, AIR 1996 SC 2073, and in view of the provisions of Section 15(2)(b) of the Indian Medical Council Act, 1956, this Court found their action to be illegal amounting to misconduct and making them, liable to criminal prosecution in view of Section 15(3) of the Act, and accordingly directed the Commissioner & Secretary, Department of Health, Medical Education and Family Welfare, Government of Bihar to take appropriate action against them."
  2. Your second query stands answered by quoting para 6 of the above judgment––

    "6. Attention was also drawn (by the counsel for physiotherapists) to the Bihar amendments in the Indian Medical Degrees Act 1916 by which the Indian System of Medicine has been brought within the ambit of the Act in addition to ‘Western Medical Science’, and it was submitted that if by virtue of amendments, brought about in 1949, the system of Medical Science is not confined to only Western Medical Sciences and it also includes Indian System of Medicine, any restriction on the Occupational Therapists and Physiotherapists to prescribe allopathic medicines has no meaning."
    • Your third query stands answered by a general reading of the above judgment, including the paras quoted above. It is clear that physiotherapy is at a different footing than medicine as such.
    • A physiotherapist does not practice medicine. He practices physiotherapy. In contrast, a neurosurgeon, a gynae–obstetrician, a psychiatrist, an MBBS, an Ayurveda or Homeopathy practitioner—all these practice medicine and are called medical practitioners or physicians.
    • The job of a medical practitioners or physician is to assess a patient for the purpose of making a diagnosis and then treat him on the basis of such diagnosis by any means at his command as appropriate. On the other hand, the job of a physiotherapist is to provide therapy through physical agents or manual exercises to a patient after he has been diagnosed by a physician and advised physiotherapy with the aim of preventing or correcting any disability.
    • It is helpful to remember that in contrast to medicine, physiotherapy is defined as follows:

      "(o) physiotherapy means medically directed therapy through physical agents including heat, cold, light, water, massage, electricity or manual exercises to persons with the aim of preventing or correcting any disability and includes occupational therapy;"

      (Section 2(o) of the THE PARAMEDICAL AND PHYSIOTHERAPY CENTRAL COUNCILS BILL, 2007, Bill No. 96 of 2007, TO BE INTRODUCED IN LOK SABHA, http://rajyasabha.nic.in/legislative/amendbills/health/councils_bill.pdf
  3. A physician who is not trained in physiotherapy can prescribe physiotherapy for a patient and can even broadly suggest the plan of physiotherapy to be given. The physiotherapist, being a specialist in the area, is competent to suggest changes in the plan suggested and refine the same.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


  • Increase in serum chloride is seen in dehydration, renal tubular acidosis, acute renal failure, diabetes insipidus, prolonged diarrhea, salicylate toxicity, respiratory alkalosis, hypothalamic lesions, and adrenocortical hyperfunction.
  • Decrease in serum chloride is seen in excessive sweating, prolonged vomiting, salt–losing nephropathy, adrenocortical deficiency, various acid base disturbances, conditions characterized by expansion of extracellular fluid volume, acute intermittent porphyria, SIADH, etc.

    For comments and archives
    IJCP Special

Dr Good Dr Bad

Situation: A patient developed asthma within a year of menopause.
Dr. Bad: It is not asthma.
Dr. Good: It is associated with menopause.
Lesson: The onset of asthma within a year of menopause is a separate asthma phenotype.

For comments and archives

Make Sure

Situation: A patient with chest pain with normal ECG died half an hour later.
Reaction: Oh my God! Why was acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Experience is a comb which nature gives us when we are bald. Proverb


To Make a Long Story Short: Something someone would say during a long and boring story in order to keep his/her audience from losing attention. Usually the story isn’t shortened.

    Mind Teaser

Read this…………………

Which of the following is not a congenital abnormality associated with juvenile polyps?

a) Malrotation
b) Meckel’s diverticulum
c) Macrocephaly
d) Mesenteric lymphangioma

Yesterday’s Mind Teaser: Which malignancy does not occur in Lynch syndrome?
a) Bronchus
b) Ovary
c) Endometrium
d) Sebaceous carcinoma

Answer for Yesterday’s Mind Teaser: a) Bronchus

Correct answers received from: Dr. Sukla Das, Dr. P. C. Das, Prabha Sanghi, Dr.K.V.Sarma, Dr.Sukanta Sen, Dr. Thakor Hitendrasinh G, Sathyamoorthy V, Dr Shagun Aggarwal, Dr.Chandresh Jardosh, Dr.A.P.Bhatia, Muthumperumal Thirumalpillai.

Answer for 1st November Mind Teaser
: b) IgA acts by activating the complement pathway.
Correct answers received from:Dr Jainendra Upadhyay, Raju Kuppusamy, Muthumperumal Thirumalpillai, Dr.Neelam Nath, Anil Bairaria, Dr Kavita, Gita Arora, DR.ANIL KUMAR Jain.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

While walking through the woods one day, I was surprised to hear a child's voice. I followed the sound, trying in vain to understand the child's words. When I spotted a boy perched on a rock, I realized why his words had made no sense: He was repeating the alphabet. "Why are you saying your ABCs so many times?" I asked him. The child replied, "I'm saying my prayers." I couldn’t help but laugh. "Prayers? All I hear is the alphabet." Patiently the child explained, "Well, I don’t know all the words, so I give God the letters. He knows what I'm trying to say."

    Medicolegal Update

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

How should a saliva sample of saliva be collected in a medico legal case?

A sample of saliva is required to be collected and preserved in the cases of oral sex, rape/acquaintance rape/date rape, sodomy, sexual assault/drug–induced sexual assault such as the molestation, inappropriate touching, forced oral contact or kissing, child sex abuse, sexual torture or any other form of allegation where exchange of saliva is anticipated on medical examination by the examining doctor.

  • The written/implied consent for examination and collection of evidences from the women alleging sexual assault must be obtained by the doctor as per section 164 A of CrPc; however, consent is not required under section 53 CrPc of India for examination and collection of evidences from the alleged accused of sexual assault.
  • Dried saliva should be collected by the doctor by a swab of normal saline.
  • Saliva is collected in a test tube, diluted with an equal volume of normal saline and placed in a boiling water bath for about 10 minutes for destroying enzymes which inactivates blood group substances, allowed to cool and transferred to a clean, sterile and well stoppered bottle, properly sealed and labeled.
  • Saliva tinged clothing must be preserved, properly sealed and labeled for further investigation

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    Public Forum

(Press Release for use by the newspapers)

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

Heart Patients– It’s November: Time to get flu shot

Flu vaccine should be taken by all heart patients as death from flu is more common among people with heart diseases than any other chronic condition, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

The American Heart Association, American College of Cardiology and Heart Care Foundation of India all recommend that all heart patients including all diabetics get flu shots.

Influenza or “the flu," is a highly contagious viral infection of the respiratory tract, which occurs from November to April, with most cases occurring between late December and early March.

Annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions.

Heart patients should only receive the flu vaccine by injection (inactivated influenza vaccine) and not the live, attenuated vaccine given as a nasal spray. The live vaccine has not been approved for use in heart patients.

Flu complications include bacterial pneumonia, dehydration and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes.

October or November is the best time to get a flu shot, but getting a shot in January or even later can still be beneficial. Flu season can start as early as October and last as late as May. It takes one to two weeks for the flu shot to take effect. Each September, a new flu vaccine is introduced. The vaccine is approximately 70 to 90 percent effective for healthy adults.

The FLUVACS study has shown that influenza vaccination reduces the risk of death and ischaemic events in patients suffering from heart attack and post-angioplasty during flu season.

Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood pressure control and other modifiable risk factors for cardiovascular disease.

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    Readers Responses
  1. Dear Dr Agarwal, This is fantastic on line journal.Subject matter is wide from medicine to a tinge of spirituality which we so much need in a profession like ours, were an emotional disconnect often happens in the rush of professional engagements.Warm Regards.Dr. A.V.Pathak.
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