Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



emedinews is now available online on www.emedinews.in and www.emedinews.org

4th   January 2010 Monday

ear Colleague, 

Medical Council of India: Professional Conduct, Etiquette and Ethics Amended

MCI has via notification number MCI-211(1)/2009(Ethics)/55667, dated 10th December 2009 has amended the "Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002". The same has been done in exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956 (102 of 1956), with the previous sanction of the Central Government.

1. The regulations are called the "Indian Medical Council (Professional Conduct Etiquette and Ethics) (Amendment) Regulations, 2009 Part I".
2.  In the "Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002", the following clause shall be added after clause 6.7.
3. 6.8 Code of Conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry, 6.8.1. In dealing with pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:-
(a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives.
(b) Travel Facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship, cruise tickets, paid vacations, etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc. as a delegate.
(C) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.
(d) Cash or Monetary Grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law/rules/guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.
(e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii) will be an imperative for undertaking any research assignment/project funded by industry for being proper and ethical. Thus, in accepting such a position a medical practitioner shall:-
(i) Ensure that the particular research proposal (s) has the due permission from the competent concerned authorities;
(ii) Ensure that such a research project (s) has the clearance of national/state/institutional ethics committee/bodies;
(iii) Ensure that it fulfills all the legal requirements prescribed for medical research;
(iv) Ensure that the source and amount of funding is publically disclosed at the beginning itself;
(v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project (s);
(vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way;
(vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document/agreement for any such assignment.
(f) Maintaining Professional Autonomy: In dealing with pharmaceutical and llied healthcare. 


   Dr KK Aggarwal

  Chief Editor


Do not take sore throat lightly
According to a study published in the Annals of Internal Medicine, pharyngitis or sore throat as it is commonly known as could indicate a more dangerous condition. Group A streptococcus is commonly implicated as the cause of pharyngitis. Sore throats in young adults and adolescents that worsen or are Strep-negative should be investigated for the presence of bacteria called Fusobacterium necrophorum. These bacteria cause a potential fatal, though rare complication, called Lemierre syndrome. F. necrophorum may cause up to 10% of sore throats in age group 15-24 years. Lemierre syndrome or postanginal septicemia occurs in healthy adolescents and young adults. It usually begins with a sore throat followed by fever, septicemia. The infection spreads to the internal jugular vein and may cause pulmonary and other distant emboli.

CT scan good but doctor's checkup more effective
Physicians from Loyola University Health System claim that a doctor's bedside thorough examination is often better than a high tech CT scan to tell what patients to be operated. Their study claims that none of the CT scan results predicted who needed to go to the operating room. Contrary to this, 30% of the bedside examined patients after being referred by doctors were scanned and found that they really needed operation. The study is published in the Journal of Neurosurgery.

Views: Continue to be on guard against H1N1 flu, says WHO
The WHO Director General has cautioned that the H1N1 flu pandemic has not ended and the virus could still mutate. She also advised to "guard against complacency" regardless of signs that the disease had peaked in some parts of Europe and North America, as the virus continued to be active in countries including India and Egypt. The pandemic needs continuous monitoring for further 6-12 months as the H1N1 flu virus could mutate into a more dangerous strain. It is important to be aware of the dangers of the Bird Flu caused by the H5N1 virus as it was more toxic and deadly than the H1N1 flu virus, she further added.

Dr Good Dr  Bad:
Situation: An elderly patient had A1C of 7.2%
Dr Bad: You need to bring it to 6.5%
Dr Good: It is adequate
Lesson: There is an emerging perception that tight glycemic control may be beneficial in primary prevention of cardiovascular disease (CVD) in younger patients with diabetes, but may become deleterious in older patients with established or subclinical CVD. Because the pathogenesis of atherosclerosis spans decades, beneficial effects of tight glycemic control on CV outcomes are mainly in younger patients without established macrovascular disease.

Make Sure: A patient of COPD & hypertension put on atenolol developed cute broncospasm
Oh my God! You should have known that atenolol is not COPD friendly.  You should have given nebivolol.
Make sure that nebivolol; a beta-1 adrenoceptor blocking agent that modulates endogenous production of nitric oxide is used and not conventional beta-1 blockers in hypertensive patients with airway dysfunction.

Lab Value to Know:Hemoglobin
Male :13.5-17.5 g/dL
Female:12-16.0 g/dL
Glycated hemoglobin: HbA1C: 5.3-7.5%

Mile Stone:
1980: The first 1000 angioplasties are  performed worldwide; NHLBI begins support of the PTCA registry.

Laughter the best medicine
When Gopal's wife ran away he got so depressed that his doctor sent him to see a psychiatrist. Gopal told the psychiatrist his troubles and said, "Life isn't worth living". "Don't be stupid, Gopal, said the psychiatrist". "Let work be your salvation". I want you to totally submerge yourself in your work. What do you do for a living? "Clean out septic tanks" Gopal replied.
Question of the day: What is Malaria Paroxysm?
Malaria causes an acute febrile illness which, in its most typical form, consists of febrile paroxysms occurring every 48 hours followed by afebrile intervals. This has a tendency to recrudesce over a period of months. These regular paroxysms separated by virtually asymptomatic intervals represent the only typical clinical feature suggestive of malaria.

The incubation period (interval between infection and first clinical sign) is about 7 days in the case of falciparum malaria (longer for other species). The febrile paroxysm may be preceded by symptoms of fatigue, headache, dizziness, nausea and vomiting for 2-3 days before the attack. Children may have convulsions.

Typically, the following sequence may be observed: A cold stage, followed by a hot stage and a sweating stage. The total duration of the attack is 8-12 hours. The interval between paroxysms is determined by the length of the erythrocytic cycle of the parasite species involved (œtertian or every 48 hours for Plasmodium falciparum, Plasmodium vivax and Plasmodium ovale; quartan or every 72 hours for Plasmodium malariae).

Splenomegaly may be the only reliable sign at this stage. Nail or palmar pallor (anemia) and dark-colored urine, may be suggestive.

In case of falciparum malaria, the paroxysm may rapidly evolve towards a severe complication of the disease (e.g., cerebral malaria or severe anemia): This is a medical emergency where diagnosis needs to be confirmed urgently and treatment started.

In non falciparum infections, fever disappears after a few paroxysms, even in the absence of treatment; relapses or recrudescences may occur a few weeks or months later.

Our Immune System is considered to be the "Basis" behind Most of the routine Ailments. Poor Immune System, leads to many Opportunistic Infections taking over, leading to a further breakdown of the Body Defence Mechanism. Most of the AutoImmune Diseases , ENT and Respiratory tract Infections and other Diseases arise from poor Body Resistance.
A Healthy Immune System is an Asset to our Body which helps us to fight against the Invading Pathogens and also to Rejuvenate Quickly. Immunity Booster Health Supplements have Become the Need of the Hour. We suffer from one aliment or another at any given point of time, and it is the sign of a Dimished Body Immunity , Hence we need something to Build up our Body, and to fight against such Infections.
 Dietary Health Supplements Containing Sodium Meta Silicate along with other Vital Nutrients is one of the most Popular Immunity Booster agents now available in the USA market. These Supplements are Known to Build up,a Strong Body Immune System, Rejuvenate and replenish our depleted energy levels , and provide a Feeling of Well being.

Formula to Practice: Estimated Average Glucose, eAG : The estimated average glucose, or eAG allows reporting of A1C values using the same units (mg/dl or mmol/l) commonly used for measurement of blood glucose. The relationship between A1C and eAG is described by the formula:eAG = 28.7 x A1C (Source: A1C-Derived Average Glucose (ADAG) study. Diabetes Care 2008;31:1-6).

Mnemonic check list for diabetes
S ight (annual eye check up)
U rine albumin
G lycosylated (A1C) hemoglobin
A therosclerosis (aspirin and lipids; palpate arteries)
R educe weight (diet and exercise) and Remove footwear (monofilament testing; foot examination)
Interesting Website: WebMD:
www.webmd.com/ Health Central: www.healthcentral.com/
Conference Calendar: PEDICON: 47th National Conference of the Indian Academy of Pediatrics, January 7-10, 2010,
Hyderabad International Convention Centre, Hyderabad. Website to know:

Quote: If your determination is fixed, I do not counsel you to despair. Few things are impossible to diligence and skill. Great works are performed not by strength, but perseverance… Samuel Johnson

Tip from other systems of medicine: Heeng: The dyspepsia prescription
People complaining of gaseous distention of abdomen may try putting heeng (asafetida) in their vegetables, pulses, etc. It is an old aged Ayurveda formula that heeng reduces gas in the body.

Medilaw: Duties owed by a medical practitioner
In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services. Medical practitioners from all fields of medicine such as Allopathy, Homeopathy, and Naturopathy can be liable under the Consumer Protection Act.

Duties which a doctor owes to his patient

A duty of care in deciding whether to undertake the case
A duty of care in deciding what treatment to give
A duty of care in the administration of that treatment.
A breach of any of these duties gives a right of action for negligence to the patient.

The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judge in the light of the particular circumstances of each case is what the law requires.

Finance Tip: What is Keyman insurance policy under the Income tax Act, 1961?
Under section 10(10D) of the Act, "Keyman insurance policy"  has been defined to mean a life insurance policy taken by a person on the life of another person who is or was the employee of the first mentioned person or is or was connected in any manner whatsoever with the business of the first mentioned person.

Thus, following are the basic ingredients of Keyman Insurance policy
1. Life Insurance policy is taken on life of Keyman by an entity.
2. Keyman can be employee, past employee of the entity. Life Insurance policy taken on any person who is connected with the business of the entity is also covered within the scope of Keyman Insurance.

In common parlance, we understand that only directors, managing director etc. are the Key Person. However, the scope is very wide as far as definition of Keyman Insurance policy is concerned under the Income Tax Act, 1961. To illustrate few examples:
1. Employer taking a life insurance policy for any employee
2. Creditor taking life insurance policy on debtor
3. Lender taking a life insurance policy on borrower etc.
Note: The above list is illustrative and not exhaustive.

Panjab & Sindh Bank 
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emedinews: revisiting 2009
IJCP Group, Heart care Foundation of India and World Fellowships of Religions are  is organizing emedinews: revisiting 2009, day long conference on the top health happenings in the year 2009 on 10th Jan 2010 at Maulana Azad Auditorium. There is no registration fee however advanced information is required.  Top experts (Dr KK Aggarwal (revisiting 2009), Dr Naresh Trehan (what's new in cardiac surgery), Dr Anupam Sibal (A decade of successful liver transplants in India), Dr Ajay Kriplani (Current Trends in the Management of Morbid Obesity), Dr Praveen Chandra (The Indications of Interventional Treatment in Cardiology), Dr Kaberi Banerjee (IVF- Where We Stand Today?), Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephroprotection), Dr. Ambrish Mithal (Diabetes), Dr Vanita Arora (ECG arrhythmias), Dr N Subramanium (Current concept in Male infertility ), Dr Neelam Mohan (Coeliac Disease), Dr. Sanjay Chaudhary (Eye Update), Dr Harish Parashar (aluminum toxicity), Dr Praveen Khillani (Whats new in field of critical care in past decade?), Dr Rohina Handa ( Whats new in rheumatology), Dr Ajay Kumar ( Fatty Liver), Dr P K Julka (Whats new in oncology), Mr.  B.N.S Ratnakar, will deliver lectures

CME will be followed by lively cultural evening guest performances by Shabani Kashyap, Vipin Aneja and perfomances by medical professional singers Dr Praveen Khilnani, Dr Lalita and Dr N Subramanium, Dr Lata Tandon, Dr Arti Pathak, Dr Sudipto Pakrasi, Dr Harjeet Kaur, Dr Ramni Narsimhan, Dr Sanjay Chugh (on the drum), Dr Yash Gulati (Anchor) Dr Reshma Aggarwal (Anchor), doctors of the year award, dance and dinner. For registration mail emedinews@gmail.com. We have crossed 1200 registrations.

1. PSB & Aviva is proud to be associated with Emedinews: Revisiting 2009. To know more about us, please visit our stall on day of the conference. http://avivaindia.com/

2. Kindly enjoy not stop tea and coffe at NESTLE counter at the conference

3. Refresh yourself with mineral water, coke and other related drinks, soda at the COKE counter.

4.  Silicic Acid is available as Sodium Meta Silicate in U.S.A and is being Launched in India During the  IJCP  Emedinews revisiting 2009 Conference at New Delhi on January 10th,2010.

Advertising in emedinews

emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact drkk@ijcp.com. emedinews@gmail.com   

Also if you like emedinews you can FORWARD it to your email addresses

medinews-revisiting 2009 Program

8.00   AM  -  8.30 PM   Dr KK Aggarwal  Revisiting the year 2009
8.30   AM  -  8.45 AM   Dr Neelam Mohan, Advances in Paedatric Diseases ( Non Liver)
8.45   AM  -  9.00 AM   Dr S C Tewari, Nephroprotection
9.00   AM  -  9.15 AM   B.N.S Ratnakar (GM CBI), Presentation
9.15   AM  -  9.45 AM   Dr Ambrish Mithal, Newer treatments in diabetes
9.45   AM  -  10.00AM   Dr Harish Parashar, Aluminium Toxicity
10.00 AM  -  10.30AM   Dr N K Bhatia, Screening for TTI
10.30 AM  -  10.40AM   Anshu Gupta, Probiotics Update
10.40 AM -   11.10AM   Dr Praveen Chandra, Indications of Cardiac Interventions            11.10 AM -   11.25AM   Dr Sanjay Chaudhary, What's new in Lasik
11.25 AM -   11.55AM   Dr Naresh Trehan, What's New in Cardiac Surgery
11.55 AM -   12.10PM   PSB-AVIVA, Presentation
12.10 PM -   12.40PM   Dr Anupam Sibal, A Decade of Succesful Liver Tansplant in India
12.40 PM -   1.10 PM    Dr Ajay Kriplani, Current Trends in the Management of Morbid Obesity
1.10   PM -   1.40 PM    DR Vanita Arora, Common Arrhythmias
1.40   PM -   2.10 PM    Dr N Subramanium, Current Concept in Male Infertility
2.10   PM -   2.40 PM    Dr V Raina, Molecular Genetics
2.40   PM -   3.10 PM    Dr Kaberi Banerjee, IVF: Where We Stand Today?
3.10.  PM -   3.25 PM    Anil Chopra (Bajaj Capital), Mutual Funds
3.25   PM -   3.40 PM    Dr Praveen Khilnani, Whats New in Critical Care in Past Decade?
3.40   PM -   4.10 PM    Dr Ajit Saxena, Erectile Dysfunction and Male Infertility
4.10  PM  -   4.20 PM    Dr Ajay Kumar, Whats New in Gastroenterology
4.20  PM -    4.30 PM    Dr Rohini Handa, Whats New in Rheumatology
4.30  PM -    4.40 PM    Dr P K Julka, Whats New in Oncology
5.00  PM Onwards Cultural hangama and awards

 Letters to the editor
Respected sir: This is regarding BRMS. Many of us do not agree that starting BRMS is not a solution for providing medical care to villages.  At the same time I would like to project one more problem. Many of the private medical colleges recently started do not have sufficient staff (doctors), but many of our beloved colleagues (practitioners) attend these medical colleges during the MCI inspections to cover the deficiencies of the staff in the respective medical colleges.  Are we not producing MBBS quacks by doing this?  How good MBBS are we producing without sufficient teachers for them.  And even MCI member knowing well about this problem is not taking this seriously.  So personally I feel there is no difference in BRMS and a person doing MBBS in private colleges.  Atleast the BRMS students are having exposure to district hospitals, where there are atleast sufficient patients.  How many of the private medical colleges are having sufficient patients for the students to get practical exposure. Anyway this is my personal feeling and I am against any of our medical fraternity attending any medical college just for MCI inspection. Thanking you sir for providing such an excellent platform and everyday teaching for us. [dr lakshmaiah]

2. Whether it is medical education or any other one, the approach has always been experimental or even emotional and not innovative which comes forth after deep thinking and discussions. Though it is being done considering "better health care" of those 70% whom the health services are inaccessible and unaffordable. The two modifications which are mentioned in this: The BRMS course and reduction of present MBBS course from four and a half year to four years or less are on the anvil the opposition by people and thinkers has started. Earlier the first MBBS course used to be of 2 full years ('60s), then one and a half year 970s & 80s) and presently one year only. May I put a suggestion for discussion: Part of human anatomy & physiology is being taught in high schools? Why not, a special paramedical studied is started at +2 level  (11th & 12th standard)  for those who intend to join medical/dental/nursing/Pharmacy/phsio & occupational therapy/Ayurveda and like courses, and the Anatomy, physiology and Biochemistry, and microbiology shifted at that level. Clinical aspects of these subjects are always covered with the clinical teaching. After completing +2, they will be eligible with preference for such courses. The MBBS course with all Para clinical & clinical teachings can easily be reduced to three and a half years or four years. It will not required then to re-merge ENT and ophthalmology with surgery, as in distant past and candidate will learn more practical aspects. Dr O P Gupta

Eye care snippets by Dr. Narendra Kumar (OptometryToday@gmail.com)
COVER TEST: The cover test is advantageously used to detect the presence of manifest strabismus even of slight degree.  It can also be used to test the steadiness of fixation and to detect the presence of heterophoria and of latent nystagmus.

To examine the presence of deviation of the visual axes for fixation of a near object.
A small fixation object is held about 1/2 meter in front of the patient's eyes; the patient is asked to look at it. The right eye is watched and left covered quickly. As soon as the left eye is covered, if the right eye makes a movement to take up the fixation, the direction of such movement indicates the direction of the squint e.g. if the right eye turns outwards to take up fixation it must have been in a convergent position before the left eye was covered; therefore there is a right convergent strabismus.  The divergent squint will present an inward movement. Likewise in a vertical strabismus, the movement will be either upwards or downwards. If, however, no movement is noticed, there is no manifest squint of the right eye.

A similar procedure is followed to examine the fixation of the left eye by covering the right eye and observing the left eye.

In some cases the fixation may be alternating, in others it may be variable, sometimes uniocular and sometimes binocular, and there may be a combination of horizontal and vertical deviations.

To examine the presence of deviation of the visual axes for fixation of a distant object.
The procedure is the same using a fixation object situated at a distance of 6 meters. The squint may exist for near but not for distance and vice versa.

The cover test is rather simple with some practice, although there may be difficulty in these cases:
(i) If the squinting eye is amblyopic and does not fix easily
(ii) If the angle of deviation is very small so that the detection of movement of the eye becomes difficult
(iii) If the child is too young so as to prevent accurate observation.

The cover test also reveals the presence and type of heterophoria (heterophoria is the tendency of the eye to deviate whereas heterotropia or strabismus or squint is the manifest deviation). When one eye is occluded, it deviates and recovery (movement) takes place to resume binocular function when the occluder is removed.

Each eye in turn is occluded. And to obtain a more relaxed angle of deviation the fixing eye is made to follow the fixation object in various directions of the gaze before removing the occluder. Here also the cover test is done using a fixation object both for near and distance.

The amount of deviation may be measured by placing prisms of increasing strength in front of the eye under examination (with their bases in the required direction e.g. base in for exophoria or inward deviation etc.) until there is no recovery movement.



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