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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 …

9th December 2012, Sunday

How to Explain Chronic Artery Disease to your Patients?

The following is how I communicate with my patients and explain to them about coronary artery disease.

  • There are three coronary arteries, which can be equated to three main roads of the city.
  • Any road has shops on each side. The coronary artery has the endothelium on the sides.
  • There are pavements in front of the shops. The pavements in coronary arteries are called intima-media.
  • When the local municipal corporation does not maintain discipline, shopkeepers start encroaching the pavement. In terms of coronary arteries, this is equivalent to intima-media thickness.
  • The next to follow are temporary encroachments of the road, which is equivalent to several plaques in the coronary arteries.
  • Then comes permanent encroachment, which is equivalent to heart plaques.
  • With encroachment, the traffic slows down and heavy honking of horns starts. This denotes angina or chest pain.
  • When the traffic congestion is heavy, motorists often blow their horn continuously. This can be equated to unstable angina.
  • When the traffic stops, but the car engine is still working, this can be likened to a heart attack.
  • When the car stops and the engine also stops, this is a cardiac arrest.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

A double blind, randomized-controlled, multicentre trial concluded that PEG 3350 (0.26 (0.11) g/kg), compared with lactulose (0.66 (0.32) g/kg), provided a higher success rate with fewer side effects in children with functional constipation. PEG 3350 should be the laxative of first choice in childhood constipation (Voskuijl W, de Lorijn F, Verwijs W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial. Gut 2004;53(11):1590-4).

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

White rice linked to diabetes in Asians

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela 2012

Large number of Nursing students took active participation in the 19th MTNL Perfect Health Mela

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

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

Valvular sclerosis in end stage renal disease is associated with progressive stenosis and increased cardiovascular mortality.

(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)

    International News

64th annual conference of CSI and SAARC Cardiac Congress 2012

Management of Acute IHD in 2012, have we reached the limits?: Dr Keith Fox, UK

  1. Higher sensitivity troponin can identify previously missed individuals with non-STEMI, and the potential for benefit (evidence will be presented)
  2. Risk scores are needed to accurately identify those for invasive therapy (evidence from NICE and GRACE programme)
  3. Novel imaging approaches can identify plaques and plaque inflammation
  4. Most MIs and deaths occur in the longer follow-up after non-STE MI and novel treatments are needed to reduce these complications (on top of current evidence based therapy).
  5. Applying evidence based therapy on a national scale (MINAP UK Programme) has resulted in striking improvements in deaths and MIs (40% decline in cardiovascular deaths in 10 years).

Growing indications for dysrhythmia management: Dr AE Buxton

  1. There are several major areas in which cardiac arrhythmias have major public health importance in diverse populations throughout the world.
  2. Atrial fibrillation affects approximately 5% of patients over 65 years of age, and 10% of patients over 75 years old. Recent developments are altering our approach to patients with atrial fibrillation, including apparently contradictory trends. On one hand, we are using less antiarrhythmic drugs to suppress atrial fibrillation, and more rate control in selected individuals. On the other hand, we are using more invasive approaches with catheter ablation instead of antiarrhythmic drugs. Trials are underway to evaluate preference of these approaches.
  3. In the area of sudden death, while implantable cardioverter-defibrillators are the primary therapy for individuals at high risk, this therapy is expensive and carries risks of its own. Multiple studies are evaluating more precise methods to determine which patients most likely to benefit from this therapy.
  4. Innovative approaches to management of arrhythmias are under investigation, including non-traditional antiarrhythmic therapies. These include spinal cord stimulation to treat heart failure and ventricular arrhythmias, as well as cardiac resynchronization therapy to both treat patients with advanced heart failure and prevent progression of heart failure.
  5. Molecular therapies are being investigated to substitute for traditional treatments. Someday, and injection of cells may be a substitute for cardiac pacemakers.

Dr John G Harold, USA: Management of endocarditis

  • There is no “cookbook” approach to proper therapy for infective endocarditis especially when considering surgery.
  • In selected patients, combined medical and surgical therapy offers substantial benefit compared with medical therapy alone.
  • Final outcome has never been related to the duration and intensity of prior antibiotic treatment, and surgery should not be delayed when clearly indicated in the vain hope that a sterile operative field can be achieved.
  • IE surgery carries significant risk and decision on whether or not to operate must be carefully thought out with good communication between surgical and medical teams.
    Twitter of the Day

@DrKKAggarwal: #AJCC CARDIOLOGY Valvular Heart Disease Update A high prevalence of mitral, tricuspid, and aortic regurgitation... http://fb.me/27KfWHyw6

@DeepakChopra: "If you have a good mental practice but you’re not connected to your body, you’re fractured." http://tinyurl.com/a2lpsdq

    Spiritual Update

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

To know the Mental States of a Person

The mental state of a person in Vedic language is described in terms of gunas. The present state of mind of any person is a result of mixing of three gunas of nature called Tamoguna, Rajoguna and Satoguna. In terms of states of mind they are called Tamas, Rajas and Satwa and the nature of a person is called Tamsic, Rajsic and Satvic.

For comments and archives

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

What are the symptoms of hydrosalpinx?

Some women with hydrosalpinx may have constant or frequent pain in their lower belly or abdomen. A vaginal discharge can also be associated with this condition.

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

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

Organ transplantation

Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient’s own body, for the purpose of replacing the recipient’s damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re–grown from the patient’s own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person’s body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source. Organs that can be transplanted are the heart, kidneys, eyes, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart. The cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.

    An Inspirational Story (Dr GM Singh)

Nothing is too big for God

Two men went fishing. One man was an experienced fisherman, the other wasn’t. Every time the experienced fisherman caught a big fish, he put it in his ice chest to keep it fresh. Whenever the inexperienced fisherman caught a big fish, he threw it back.

The experienced fisherman watched this go on all day and finally got tired of seeing this man waste good fish. "Why do you keep throwing back all the big fish you catch?" he asked. The inexperienced fisherman replied, "I only have a small frying pan."

Sometimes, like that fisherman, we throw back the big plans, the big dreams, the big jobs and the big opportunities that God gives us. Our faith is too small. We laugh at that fisherman who didn’t figure out that all he needed was a bigger frying pan; yet how ready are we to increase the size of our faith?

Whether it’s a problem or a possibility, God will never give you anything bigger than you can handle. That means we can confidently walk into anything God brings our way.

For comments and archives

    Cardiology eMedinewS

Diabetes and CAD- Difficult management issues: Dr Amal K Banerjee
Read More

CAD Management in Asia: Socioeconomic challenges: Dr Ashok Seth Read More

    Pediatric eMedinewS

Study Shows Cases Of C. Diff Increased 12-Fold Among Children
Read More

Half Of Autism Diagnoses Made At School Age Read More

    IJCP Special

Dr Good Dr Bad

Situation: A mitral stenosis patient from a remote village came for surgery.
Dr. Bad: A mechanical valve will suffice.
Dr. Good: You need Bioprosthetic valve.
Lesson: Bioprosthetic valves are recommended for any patient who cannot or will not take oral anticlotting drugs or when there is a clear contraindication to them.

Make Sure

Situation: A patient with Chikungunya had persistent joint pain.
Reaction: Oh my God! Why was Hydroxychloroquine not given?
Lesson: Make sure that all patients with post Chikungunya arthritis are treated with Hydroxychloroquine to reduce chances of death.

    Legal Question of the Day

(Ex)Prof. M C Gupta, Advocate & Medico-legal Consultant)

What is the difference in compensation payable in medical negligence and road accident cases?

QUESTION—What is the difference in the method of calculating the amount of compensation payable in medical negligence cases and motor vehicle accident cases?


  1. There is no fixed formula in medical negligence cases. The following principles apply:

    a—The compensation is awarded by consumer courts (actually, tribunals known as forum / commission) set up under the Consumer protection Act, 1986.

    b—There is no compensation if there is no negligence.

    c—The onus to prove negligence lies upon the complainant.

    d—Courts generally look decide medical negligence on the basis of expert medical opinion.

    e—The usual formula is the income level of the patient multiplied by the period for which the income ceased. Some amount is also allowed for mental agony and harassment. A small amount of legal costs are also allowed.
  2. There is a defined method to calculate compensation in accident cases. The following principles apply:

    a—The compensation is awarded by Motor Accident Claims Tribunals (MACT) set up under section 165 of the Motor Vehicles Act, 1988.

    b—Claims can be of three types:

    i)—Claims under section 140 of the Motor Vehicles Act, 1988, titled as—“ 140. Liability to pay compensation in certain cases on the principle of no fault.” Obviously, no fault on anybody’s part needs to be proved here.

    ii)-- Claims under section 163A of the Motor Vehicles Act (MVA), 1988, titled as—“163A. Special provisions as to payment of compensation on structured formula basis.” The structured formula is given in Schedule 2 of the MVA.

    In terms of section 163A(2), no fault needs to be proved here. You need not to prove the negligence of offending vehicle and it is immatarial if the victim was himself negligent.

    Section 163A(2) is reproduced below:

    “(2) In any claim for compensation under sub-section (1), the claimantshall not be required to plead or establish that the death or permanent disablement in respect of which the claim has been made was due to any wrongful act or neglect or default of the owner of the vehicle or vehicles concerned or of any other person.”

    iii)-- Claims under section 166 of the Motor Vehicles Act (MVA), 1988, titled as—“Application for compensation.”

    Under this option you have to prove the negligence of driver/owner of offending vehicle and if the victim was also negligent the compensation shall be apportioned in the ratio of negligence.
  3. Maximum compensation awarded so far has been Rs. 1.72 crores under the CPA (Malay Ganguli case) and Rs. 20 crores under the MVA (Patricia Jain case).
  4. Paymentof the compensation amount in MVA / MACT cases is mainly that of the insurance company because vehicle insurance is compulsory. Professional indemnity insurance by doctors is not compulsory but is highly advisable.
  Quote of the Day (Dr GM Singh)

The definition of the word life can't be completed without using the word emotions. Some people work in emotions whereas others work with emotions.So it's very important to understand how people are using their emotions.

    Mind Teaser

Read this…………………

Which description of pain would be most characteristic of a duodenal ulcer?

A. Gnawing, dull, aching, hungerlike pain in the epigastric area that is relieved by food intake
B. RUQ pain that increases after meal
C. Sharp pain in the epigastric area that radiates to the right shoulder
D. A sensation of painful pressure in the midsternal area

Yesterday’s Mind Teaser: Included in the plan of care for the immediate post-gastroscopy period will be:

A. Maintain NGT to intermittent suction
B. Assess gag reflex prior to administration of fluids
C. Assess for pain and medicate as ordered
D. Measure abdominal girth every 4 hours

Answer for Yesterday’s Mind Teaser: B. Assess gag reflex prior to administration of fluids

Correct answers received from: Dr. P. C. Das, Dr Bharat bhushan aggarwal. Dr.K.V.Sarma, Prabha Sanghi, Muthumperumal Thirumalpillai, Dr.(Maj. Gen.) Anil Bairaria, DR ARPAN GANDHI, Dr Pankaj Agarwal, Dr. Thakor Hitendrsinh G, DR Chandresh Jardosh, Dr Avtar Krishan, Dr Kanta jain, Dr Jainendra Upadhyay

Answer for 7th December Mind Teaser: C. Keep legs elevated on 2 pillows while sleeping

Correct answers received from: Archna Parwani

Send your answer to ijcp12@gmail.com

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

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    Laugh a While (Dr.Chandresh Jardosh)

Model Stools

I was in Target the other day, shopping with a young lady friend. We were walking past the furniture section where there were several different models of bar stools on display. Next to them there was a sign that read: "All models in stock now!"

So I paused next to the display and said, "Do you know what these are?" "What?" she asked.

I said, "Stool samples."

    Medicolegal Update

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

What is the nature of bullet wounds of the head?

In most cases of these injuries, the bullet passes completely through the skull. As it enters the skull, it produces a clean cut hole in the outer table and a larger hole in the inner table. At the exit point, these conditions are reversed and the hole in the outer table is larger than the hole in the inner table. These facts are often of importance in determining the direction of fire in bullet injuries of the head. The track of a bullet through the brain tissues varies greatly, depending on the range and stability of the bullet. On the other hand, if it remains high velocity at the time of impact with the skull, there may be considerable damage from the cavitation effect within the skull.

  • Fissured fractures often radiate through the vault and base of the skull from the bullet entrance and exit holes.
  • In certain bullet injuries of the head, the bullet may fail to emerge from the skull and in these cases an area of bony comminuting is often found at the site of lodgment.
  • When a bullet strikes the head at a tangent, penetration of the skull may fail to occur, but the force of the bullet may be sufficient to fragment the inner table at the site of impact. Delayed pressure effects and cranial edema may be produced as a result of this.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Bad teeth are related to bad heart arteries

New Delhi: Saturday, 8 December 2012: Winter, more heart disease, more blood pressure, more heart attacks, more paralysis. Its time to go to not only to your cardiologists but also to your dentist as in middle-aged adults, gum disease goes hand in hand with the metabolic syndrome and heart disease, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Metabolic syndrome is a cluster of risk factors for heart disease, paralysis and diabetes -- including high blood pressure, abdominal obesity, high blood sugar, low levels of "good" HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is usually diagnosed when a person has three or more of these traits. There is a link between periodontitis, an infection of the tissue supporting the teeth seen in up to 40 percent of adults, and system-wide problems such as low grade inflammation and a reduced ability to metabolize glucose.

Quoting a study published in the Journal of Clinical Endocrinology and Metabolism, Dr Aggarwal said that people with periodontitis are also at about 20 percent greater risk of heart disease.

Both periodontitis and the metabolic syndrome are linked to inflammation and resistance to insulin.

In the study 34% percent of people with moderate periodontitis and 37% with severe periodontitis had the metabolic syndrome, compared to just 18 percent of people with no gum disease or only mild periodontitis.

The likelihood of being diagnosed with metabolic syndrome rose with the severity of bleeding in the gums, as well as the proportion of periodontal pockets, or abnormally deep spaces between teeth and gums. The relationship was especially strong among people 40 and older.

Adults older than age 45 suffering from severe periodontitis were 2.3-times more likely to have metabolic syndrome than unaffected individuals.

In the study treating severe periodontitis resulted in better blood vessel function six months later.

    Readers Responses
  1. Dear Dr Aggarwal, Not only is your daily email very informative and educative at times, the new quiz has certainly started getting those grey cells activated once again Keep it up. Dr Arpan Gandhi
    Forthcoming Events

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