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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 …

23rd September 2011, Friday

Will India import P1 polio from Pakistan?

India is on high alert against the deadly polio P1 virus coming from Pakistan Indian health ministry has asked the Punjab government to mandatorily vaccinate all children aged 0–5 years coming Pakistan for the next four months.

Pakistan till now has recorded 84 cases of polio of which 83 are of the P1 strain, a deadly dangerous since it travels faster and infects more people.

Polio also has re–entered China after a gap of 10 years with polio virus imported from Pakistan. China’ last indigenous case was in 1994, and it’s very last case – imported that time from India – was in 1999. After the recent outbreak, the Chinese government has decided to immunize 4.5 million children.

India has reported just one case. Last case was reported on January 13 in West Bengal. Punjab has been polio free since 2009.

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

Will India import P1 polio from Pakistan?

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

18th MTNL Perfect Health Mela to be Multi-Locational

In a press conference at Russian Culture Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Perfect Health Mela announcing about the upcoming 18th MTNL Perfect Health Mela

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


Most heart events avoidable

PUNE: Every year 17.1 million lives are claimed across the world by cardiovascular diseases, with 82 per cent of deaths occurring in low– and middle–income countries. Majority of these deaths could be prevented through steps such as eating a healthy diet, regular physical activity and avoiding tobacco, cardiologist Shireesh Sathe, director of cardiology department at Deenanath Mangeshkar Hospital (DMH), said at a press conference here on Friday. "However, not all heart events are preventable. If one suspects a family member of having a heart attack (myocardial infraction) or stroke, medical help should be sought immediately. Over 70 per cent of all cardiac and breathing emergencies occur at home when a family member is available to help a victim. There are treatments available through which the lives of our loved ones can be saved," said Sathe. He was speaking ahead of the World Heart Day that falls on September 29. ‘One World, One Home and One Heart’ is this year’s theme. (Source: TOI, Sep 19, 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)

HFSA: Heart failure risk rises as the blood boils

Individuals who are prone to getting angry may have a higher risk for heart failure, researchers found.
In a study of black and white men and women, high levels of anger were associated with a greater risk of developing heart failure (HR 1.48, 95% CI 1.25 to 1.76), according to Anna Kucharska–Newton, PhD, MPH, of the University of North Carolina Gillings School of Global Public Health in Chapel Hill. And in those who were hospitalized for heart failure, high anger levels were associated with a greater risk of getting readmitted; the average number of readmissions was about 4.5 for those with low anger levels and about five for those with high levels, she reported at the Heart Failure Society of America meeting here. (Source: Medpage Today)

For comments and archives

Dialysis timing linked to mortality, morbidity

Going more than a day between dialysis sessions may boost a multitude of health risks for end–stage renal disease patients, a national study showed. Overall mortality and death from cardiac causes, cardiac arrest, myocardial infarction, and infections were significantly elevated after the two-day interval on a three–times–a–week dialysis schedule, Robert N. Foley, MB, of the U.S. Renal Data System and University of Minnesota in Minneapolis, and colleagues found. (Medpage Today)

For comments and archives

Screening ECG still not supported by evidence

No new evidence has surfaced since 2004 to justify screening asymptomatic adults for coronary artery disease (CAD) with resting or exercise ECG, according to a literature review by the U.S. Preventive Services Task Force (USPSTF). While studies show that abnormalities on ECG are indicative of future cardiovascular events, no studies assessed outcomes between screened and unscreened populations, Roger Chou, MD, from the Oregon Health & Science University in Portland, and colleagues found. In addition, no studies evaluated how screening would affect intervention for cardiovascular risk or how screening could better risk–stratify people compared with traditional risk factors, according to the study published in the Annals of Internal Medicine. (Medpage Today)

For comments and archives

   Fitness Update

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

Being physically active is important, even if started later in life

It is well–known by most Americans that a physically active lifestyle and a high level of fitness are important for long–term health and longevity. However, no population–based research study has ever measured the relationship of physical activity levels and peak oxygen uptake over a long period of time. A new research study published in the journal Medicine & Science in Sports & Exercise does exactly that, and the authors have some interesting conclusions about fitness.

Researchers at the Norwegian University of Science and Technology followed 1,843 men and women who were between 18 and 66 years old at the beginning of the study, for 23 years. Researchers surveyed all participants on their physical activity habits, including duration, frequency and intensity of activity. They also measured their peak oxygen consumption rate, which is used to measure cardiorespiratory fitness, at various intervals. At the end of the study, people who were more active had a significantly higher level of cardiorespiratory fitness, as expected. However the researchers also noted that those who started off with a low amount of exercise in younger years and increased their levels of activity were more fit than those who did not, even if they started exercising much later in life.

For comments and archives

   Twitter of the Day

@DrKKAggarwal: This one step – choosing a goal and sticking to it – changes everything.

@DeepakChopra: #CosmicConsciousness If you see your infinite potential, the world is yours

    Dr KK Answers

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

How to handle patients on nitrates who wants to take Viagra group of drugs?

  1. Men treated with PDE–5 inhibitors (Viagra group of drugs) and nitrates are at risk for severe hypotension and syncope (loss of consciousness).
  2. Co–administration of Viagra group of drugs (sildenafil) with isosorbide mononitrate or sublingual nitroglycerin lowers blood pressure (52/29 mmHg with isosorbide mononitrate and 36/21 mmHg with sublingual nitroglycerin).
  3. In men on Viagra group of drugs with chest pain, nitrates should not be administered for 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil.

For comments and archives

    Spiritual Update

Formulas and rules for preventing heart attacks

One can prevent heart attacks. Nine preventable risk factors are responsible for 90% of heart attacks. They are (in order of importance)

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Can rules be different in rural/urban areas and for government and practicing doctors?

I think rules should be the same for everybody. I think that governments mend and bend rules for their own convenience. The following examples support my statement:

  • An MBBS doctor in PHCs/Dist. hospital is allowed to perform tubal ligations, obstetric emergency surgeries, and even to administer general anesthesia but this is not permitted in private practice, especially in urban areas.
  • An MBBS doctor in a PHC is allowed to perform pathological tests for patients coming to the PHC but this is not permitted in private practice, especially in urban areas.


  1. Rules cannot be the same for everybody in all situations. Law is meant to help society, not to hamper it. Rules have to be such that they are appropriate to the place where they apply. That is the reason why there are separate Union and State lists in Schedule 7 of the Constitution as regards competence to make laws. Subjects in the state list are those where state governments can make their own laws which may vary from state to state. Rules can vary even within a state. Taxation laws can vary among rural and urban areas. The permissible age for drinking is 21 years in some states, 25 in Delhi and Maharashtra and 30 in Wardha district of Maharashtra. If somebody thinks that a law is wrong, the proper course is to challenge it in the court and get it quashed. For example, actor Imran Khan has very recently challenged in Mumbai High Court the Maharashtra policy of keeping the permissible age for drinking very high.

    Laws vary even from country to country. Death penalty has been abolished in most countries of the world but continues in the most populous countries like China, India, USA and Pakistan. Death penalty has been challenged in courts but held to be legal by the SC. It will become illegal the day the parliament amends the constitution accordingly. Hence, we need to accept a situation whereby peoples’ representatives make differential laws for the people for their benefit.
  2. Rules have to be applied keeping in mind the ground situation which cannot be the same in all circumstances. It is the duty of the government to use its discretion and apply laws in different situations in the best interest of the society. There is nothing wrong in it. However, while exercising administrative discretion, the authorities must not commit illegality. When it is felt that government action is differential to the extent of being biased and illegal, the remedy against such illegality lies in the courts.
  3. If an MBBS doctor is trained in performing tubal ligations and possesses a proper certificate of such training, there is no reason why he cannot do even though he may be in private practice. There is no law against it.
  4. There is no law that an MBBS cannot perform obstetric emergency surgeries, even in private practice, if it is a question of saving life and no qualified specialist is available to the patient for the purpose.
  5. There is no law that an MBBS cannot administer anesthesia in an emergency, even in private practice, if it is a question of saving life and no qualified specialist is available to the patient for the purpose.
  6. There is no law that an MBBS in private practice even in an urban area cannot himself perform simple pathological tests for his own patients for which he has been trained, provided he does not extend this facility to the general public for consideration and thereby allow himself to be perceived as running a pathlab in which case he would be liable in law for practicing pathology without being a pathologist.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)


Morality may consist solely in the courage of making a choice. Wickedness is always easier than virtue, for it takes a short cut to everything. But over time you learn, you can’t make wrong work. There are always two choices, two paths to take. One is easy. And your only reward is that it’s easy. You cannot do wrong without suffering wrong.

Work joyfully and peacefully, knowing that right thoughts and right efforts will inevitably bring about right results.

You can never lose anything that really belongs to you, and you can’t keep that which belongs to someone else.

You always experience the consequences of your own acts. If your acts are right, you’ll get good consequences; if not, you’ll suffer for it.

Sooner or later everyone sits down to a banquet of consequences.

For comments and archives

    Medicine Update

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

Can lactose intolerance be dangerous?

No, except for less calcium and good protein intake, ingestion of lactose will cause only transient symptoms. There is no long term risk of developing cancer!

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

CUPART 2011 (Current Practices and Recent Advances in ART)

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

For Registration Contact: Address:
E–23 Ayurvigyan Nagar New Delhi – 110049

For details contact +91 9871250235

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

RDW (Red cell Distribution Width)

The red cell distribution width is a numerical expression which correlates with the degree of anisocytosis (variation in volume of the population of red cells). It can be used

  • To differentiate thalassemia from iron deficiency anemia (this use is not universally accepted)
  • To monitor the results of hematinic therapy for iron–deficiency or megaloblastic anemias; as new, normally–sized cells are produced, the RDW increases at first, but then decreases as the normal cell population gains the majority.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient of diabetes was on rosiglitazone.
Dr. Bad: Continue to take it.
Dr. Good: Stop it.
Lesson: Due to accumulating evidence of increased cardiac risk, European Medicines agencies including the Drug Controller General of India (DCGI) have suspended the sale of rosiglitazone.

For comments and archives

Make Sure

Situation: A patient of asthma worsened on aspirin.
Reaction: Oh my God! Why was history of allergy not taken?
Lesson: Make Sure that patients with asthma are not given aspirin without asking a history of allergy.

For comments and archives

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  Quote of the Day

(Dr. GM Singh)

Through humor, you can soften some of the worst blows that life delivers. And once you find laughter, no matter how painful your situation might be, you can survive it. Bill Cosby


Long in the tooth: Old people (or horses)

  Sri Chanakya Niti-Sastra: The Political Ethics of Chanakya Pandit

(Dr Anupam Sethi Malhotra)

Even a pandit comes to grief by giving instruction to a foolish disciple, by maintaining a wicked wife, and by excessive familiarity with the miserable.

    Medicolegal Update

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

What is disinterment in Forensics?

To dig up something buried, especially a corpse is called disinterment

  • Many early groups buried the corpse in the ground and exhumed it at a later date for religious rituals, a practice still undertaken by some traditional societies.
  • In fourteenth–century France, it became common procedure to dig up the more or less dried–out bones in the older graves in order to make room for new ones.
  • The high death rate from the European plagues coupled with a desire to be buried in already–full church cemeteries led to old bones being exhumed so that new bodies could be placed in the graves. In times past, on rare occasions prior to embalming, the body was removed from the ground. This happened when burial professionals or the authorities suspected that the person might have been buried alive.
  • The French philosopher and death expert Philippe discussed necrophiliacs who disinterred dead bodies for sexual purposes and scientists who dug up corpses to conduct scientific experiments.
  • It is common knowledge that for centuries until cadavers were legally provided medical schools exhumed dead bodies for teaching purposes. One of the reasons the use of the wake was enacted in many societies was to deter those who might steal corpses.
  • To test methods for preventing or slowing down the process of postmortem decay. U. Mobus and colleagues describe an usual case of exhumation, in which a young person "exhumed" a child's body involved in a road accident because he wanted to test methods for preventing or slowing down the process of postmortem decay.

(Ref: Anil Aggrawal’s Internet Journal of Forensic Medicine and Toxicology Volume 2, Number 2, July–December 2001)

For comments and archives

    Mind Teaser

Read this…………………

On immunohistochemistry, classical Hodgkin’s lymphoma Reed sternberg cells are likely to be:

a. CD15(–), CD 30(+), CD45(–)
b. CD15(+), CD 30(+), CD45(+)
c. CD15(+), CD 30(+), CD45(–)
d. CD15(–), CD 30(+), CD45(+)

Yesterday’s Mind Teaser: The most common subtype of Hodgkin’s lymphoma seen in children in India is

a. Nodular sclerosis
b. Mixed cellular
c. Nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL)
d. Lymphocyte rich classical Hodgkin’s lymphoma (LRCHL)

Answer for yesterday’s Mind Teaser: b. Mixed cellular

Correct answers received from: Dinesh Yadav, Dr YJ Vasavada, Dr Shikha Jain, Dr Chandresh Jardosh, Dr K Raju, Ramesh P, Dr Neelam Nath, Dr Jainendra Upadhyay, Anil Bairaria, Dr Anupam Sethi Malhotra.

Answer for 21st September Mind Teaser: d) Pancreatic YY
Correct answers received from: Dr Jainendra Upadhyay, Anil Bairaria, Dr Anupam Sethi Malhotra.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)


After driving up and down several lanes, I finally found a parking spot at the shopping mall. I noticed another man driving very slowly in the same direction, and, since he was closer, I gave him the "Are you going to park there?" look.

His responding gestures were very confusing. First he shook his head. Next he pointed at me, then at the parking space and then at himself, his watch and the mall. Finishing off, he frowned, raised his palms upward and shrugged. Once I parked, I walked over to the driver to make sure he didn’t want the space. "You must be single," he replied. "If you were married, you would've known that was the universal sign for ‘Go ahead and take the spot. I’m waiting for my wife.’"

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Calf lung surfactant Intratracheal Suspension containing

Phospholipids… 35mg (containing 26 mg phosphatidylcholine of which 16mg is disaturated phosphatidylcholine)

Proteins…0.65mg (including 0.26mg of surfactant associated proteins B) per ml
(a). As a prophylaxis therapy for premature infants <29 weeks of gestational age at significant risk for respiratory distress syndrome (RDS).

(b). For the treatment of infants <72 hours of age with RDS (confirmed by clinical and radiologic findings) and requiring endotracheal intubation.
    Public Forum

(Press Release for use by the newspapers)

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

Do not ignore early morning chest pain

The circadian variation in frequency of heart attack, sudden cardiac death, and heart pain is characterized by a morning peak, said Padma Shri and Br B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Maximum heart attacks and sudden heart death occur between the hours of 6 a.m. and noon compared to the rest of the day.

Cardiac events are triggered stimulation of sympathetic nervous system. Fibrinolytic or the clot–dissolving capacity is also low in the morning. Among patients with stable heart blockages, plasminogen activator inhibitor–1 activity peaks in the early morning while tissue plasminogen activator activity is at its nadir.


  1. If you are a heart patient, do not smoke just after getting up. It can increase the sympathetic activity.
  2. If you are a heart patient, do not take a cup of tea or coffee immediately after getting up. It can increase the sympathetic activity
  3. Heart patients should take their drugs in the night so that the drug is available in the blood in the morning hours
  4. Heart patients should not exercise early in the morning if they have not taken their morning drug or the previous night drugs.
  5. Heart patients should not do Kapalbhati or Bhastrika pranayama without medical supervision.
  6. Early morning anger can be harmful.
  7. Early morning is more harmful in winter and near full moon.
  8. Early morning is more harmful in diabetic patients.
  9. Early morning is more harmful in uncontrolled blood pressure patients.
  10. Beta blockers and aspirin can prevent early morning heart attack and sudden heart death.

For comments and archives

    Readers Responses
  1. Dear Sir, Hats off to you for the fantastic work effort. Regards Dr Parul.
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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    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