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emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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; Member 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


Dear Colleague

5th March 2010, Friday

 Blood sugar levels once considered normal are not safe for baby and mother

More pregnant women may soon be diagnosed and treated for gestational diabetes, as per new guidelines. According to a study by investigators at Northwestern University Feinberg School of Medicine, more than 16 percent of the entire population of pregnant women will qualify as having gestational diabetes (Dr Boyd Metzger, Tom D. Spies Professor of Metabolism and Nutrition, Feinberg, Physician, Northwestern Memorial Hospital). Earlier, between 5 to 8 percent of pregnant women were diagnosed with gestational diabetes.

 Blood sugar levels that were once considered in the normal range are now seen as causing a sharp increase in the occurrence of overweight babies with high insulin levels, early deliveries, cesarean section deliveries and potentially life–threatening pre–eclampsia. The study will is being published in the March issue of Diabetes Care, a journal of the American Diabetes Association.

 Based on a study of more than 23,000 women in nine countries, Metzger and an international group of 50 experts concluded a fasting blood sugar level of 92 or higher, a one–hour level of 180 or higher on a glucose tolerance test or a two–hour level of 153 or higher on a glucose tolerance test constitute serious risks to the mother and baby. Previously, these levels had been considered in the safe, normal range, and two elevated levels were required for a diagnosis of gestational diabetes. At these levels, the frequency of having an overweight baby is almost double, the frequency of having preeclampsia is almost double, and the frequency of early delivery is 40 percent greater.


 Dr KK Aggarwal

Chief Editor

News and Views

Injectable Victoza gets green signal for type 2 diabetes

In January this year, Victoza (liraglutide) was accorded FDA–approval for administration as an adjunct to diet and exercise for treatment of type 2 diabetes in adults. A human GLP–1 (glucagon–like peptide–1) analogue, Victoza is administered as a once–daily injection. It may be used as a monotherapy in second–line treatment for diabetes and in combination with other commonly prescribed oral antidiabetic drugs.

Diuretics plus calcium channel blockers linked to increased myocardial infarction risk

In patients with hypertension, treatment with diuretics plus calcium channel blockers was associated with a higher risk of myocardial infarction (MI), finds a study published in the BMJ. Compared with patients who received diuretics along with beta blockers, patients treated with diuretics plus calcium–channel blockers were found to have significantly increased risk of MI (adjusted odds ratio (OR) 1.98, 95% confidence interval 1.37 to 2.87) but not of stroke (OR 1.02, 95% CI 0.63 to 1.64). The risks of myocardial infarction and stroke in users of diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers were slightly but not significantly lower than in users of diuretics plus beta blockers (myocardial infarction: OR 0.76, 95% CI 0.52 to 1.11; stroke: OR 0.71, 95% CI 0.46 to 1.10). (Source: BMJ 2010;340:c103)

What you eat after exercise matters (Dr G M Singh)

Many of the health benefits of aerobic exercise are due to the most recent exercise session, and the nature of these benefits can be greatly affected by the food we eat afterwards, according to a study. Specifically, the study found that exercise enhanced insulin sensitivity, particularly when meals eaten after the exercise session contained relatively low carbohydrate content. Enhanced insulin sensitivity means that it is easier for the body to take up sugar from the blood stream into tissues like muscles, where it can be stored or used as fuel. Impaired insulin sensitivity is a hallmark of type 2 diabetes, as well as being a major risk factor for other chronic diseases, such as heart disease.

Conference Calendar

2nd Indo–American Emergency Medicine CME
(Organized by IMA, SEMI, MIMS & George Washington University, USA)
Date: March 13–14, 2010.
Venue: Malabar Institute of Medical Sciences Ltd (MIMS), Calicut
Contact: Dr Abdul Jaleel 09447121977, Email:emcme2010@gmail.com

Quote of the Day

Prayer does not change God, but it changes him who prays. (Søren Kierkegaard)

Diabetes Fact

Thiazolidinediones: pioglitazone, rosiglitazone (banned); retain sodium, cause HT and CHF; PPAR gamma receptor agonist, may cause liver dysfunction.

Public Forum (Press Release)

International Women’s Day: Women and diabetes

On the occasion of International Women’s Day, have your sister, mother, aunt or the beloved one get a blood sugar check up done, suggested Heart Care Foundation of India. Diabetes affects up to 10% of women and one-third of diabetic women who are unaware of their illness.

Diabetes is a unique condition for women. When compared with men, women have a 50 percent greater risk of diabetic coma, a condition brought on by poorly controlled diabetes and lack of insulin.

Women with diabetes have heart disease rates similar to men, but more women with diabetes die from a first heart attack than do men with diabetes.

The risk for cardiovascular disease, the most common complication attributable to diabetes, is more serious among women than men. Deaths from heart disease in women with diabetes have increased 23 percent over the past 30 years, compared to a 27 percent decrease in women without diabetes.

Women with diabetes are 7.6 times as likely to suffer peripheral vascular disease (PVD) than women without diabetes. PVD is a disorder resulting in reduced flow of blood and oxygen to tissues in the feet and legs. The principal symptom of PVD is intermittent claudication (pain in the thigh, calf, or buttocks during exercise).

Diabetes also poses special challenges during pregnancy. Compared with women who don't have diabetes, women with diabetes are up to five times more likely to develop toxemia, a disorder marked by hypertension, protein in the urine, swelling, headache, and visual disturbances.

Diabetes during pregnancy (gestational diabetes) increases risk for problems such as high birth weight, birth defects, and other complications for the mother.

Macrosomia, or large birth weight occurs 2 to 3 times more often in diabetic pregnancies as in the general population. Because of the increased risk of fetal macrosomia, women with diabetes are 3 to 4 times more likely to have a cesarean section.

The rate of major congenital malformations in babies born to women with pre–existing diabetes varies from 0 to 5 percent among women who receive preconception care to 10% among women who do not receive preconception care.

Between 3 to 5 percent of pregnancies, in diabetic women, result in death of the newborn within 28 days. This compares to a rate of 1.5% for women who do not have diabetes.

Children born of mothers who developed gestational diabetes are more likely to be overweight or obese during adolescence and therefore are at greater risk for diabetes as well.

Women who have had gestational diabetes are at increased risk for developing type 2 diabetes later.

Approximately 40 percent of women with gestational diabetes who are obese before pregnancy develop type 2 diabetes within 4 years. The chance of developing diabetes during this same period is lower if the women are less overweight.

Birth control pills can affect blood glucose levels and diabetes control. And because women with diabetes are already at higher risk of infection, most women with diabetes should not use an intrauterine device because it may lead to infections.

Question of the day

What are the distinguishing criteria for inflammatory bowel disease?

Diagnosis is based on identifying positive symptoms (e.g. Rome criteria) consistent with the condition and excluding other conditions with similar clinical presentations in a cost–effective manner.
Rome II Diagnostic Criteria for IBS
Atleast 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two of three features:

  1. Relieved with defecation

  2. Onset associated with a change in frequency of stool

  3. Onset associated with a change in form (appearance) of stool

Symptoms that cumulatively support the diagnosis of IBS

  1. Abnormal stool frequency (for research purposes, ‘abnormal’ may be defined as greater than three bowel movements per day and less than three bowel movements per week)

  2. Abnormal stool form (lumpy/hard or loose/watery stool)

  3. Abnormal stool passage (straining, urgency or feeling of incomplete evacuation)

  4. Passage of mucus

  5. Bloating or feeling of abdominal distension. The diagnosis of a functional bowel disorder always presumes the absence of a structural or biochemical explanation for the symptoms. (Source: Gastroenterology 2002:123(6):2105–2007.)


eMedinewS Try this it Works

Cold compresses beat heat in treating chalazions

Cold compresses applied early in the process and every two hours for at least 2 days can rapidly resolve nearly all chalazions in 2 to 3 days.

Dr Good Dr Bad

Situation: A diabetic patient came with headache.
Dr Bad: Get a CT head done.
Dr Good: Rule out glaucoma first.
Lesson: The risk of glaucoma has been reported to be 1.6–4.7 times higher in individuals with diabetes than in non diabetic individuals. (Source: Diabetes Care 2008;31:1905–1912.)

Make Sure

A patient with angina and abnormal endothelial functions was put on atenolol.
Oh my God! Why did you not consider nebivolol?
Make sure that nebivolol is used as the beta–blocker of choice in patients with proven endothelial dysfunction. (Source: Kardiologiia 2004;44(2):15–18)

Medi Finance
(BUDGET 2010–2011)

Direct Taxes Individual

Income tax slabs for resident senior citizen taxpayers to be as follows:

Income upto Rs 2.4 lakh Nil
Income above Rs 2.4 lakh and upto Rs. 5 lakh 10 %
Income above Rs.5 lakh and upto Rs. 8 lakh 20 %
Income above Rs. 8 lakh 30 %
Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

The Balloonist and the Engineer (Dr Mayur Jain)

Realizing he was lost, a balloonist dropped down to ask directions. "Excuse me, but I’m a little off course" he shouted. "I promised to meet a friend an hour ago; I don’t know where I am."

A woman hollered back: "You’re in a hot air balloon hovering approximately 30 feet above the ground. You’re at exactly 40 degrees, 22 minutes, and 21 seconds North latitude and 70 degrees, 30 minutes, and 33 seconds West longitude." "Amazing," the balloonist replied. "You must be an engineer!" "I am," she replied, "How did you know?"

"Well," answered the balloonist, "everything you told me is technically correct, but I can’t use your information. I’m still lost and you haven’t been much help at all. If anything, you’ve delayed my trip."

The woman thought for a moment, then replied: "You must be in management." "I am," replied the balloonist, "but how did you know?"

"Well," said the woman, "you don’t know where you are or where you’re going. You’ve risen to your position due to a large quantity of hot air. You made a promise that you have no idea how to keep, and you expect people beneath you to solve your problems."

"In fact," she said, "you’re in exactly the same position you were before we met, but somehow it’s now my fault."

Formulae in Critical Care

Osmolar gap
Osmolar gap = Measured Posm – Calculated Posm

Milestones in Neurology

Oliver Wolf Sacks, CBE, FRCP (1933, London, England), a British neurologist, is a professor of neurology, psychiatry and writing at Columbia University, where he also holds the title of Columbia Artist. He previously spent many years on the clinical faculty of Yeshiva University's Albert Einstein College of Medicine.

Sacks is the author of several bestselling books, including several collections of case studies of people with neurological disorders. His 1973 book Awakenings was adapted into an Academy Award–nominated film of the same name in 1990 starring Robin Williams and Robert De Niro. Most recently, the author and his book Musicophilia: Tales of Music and the Brain were the subject of an episode of the PBS series Nova.

Mistakes in Clinical Practice

Include allergies and age and weight of patient on prescriptions when possible.

11th March World Kidney Day (Dr N P Singh)

Kidney diseases are harmful: Common causes of CKD include inflammatory diseases of the kidney, infections, obstruction in the urinary tract and inherited disorders like polycystic kidney disease. But in both developed and developing nations, diabetes and hypertension are becoming the most common causes of CKD, especially in older people. These are also the most common causes of cardiovascular disease (CVD).

The first consequence of undetected CKD is the risk of developing progressive loss of kidney function leading to kidney failure and the need for dialysis treatment or a kidney transplant. The second is premature death from associated cardiovascular disease. Individuals who appear to be healthy and who are then found to have CKD have an increased risk of dying prematurely from CVD (coronary disease, cerebrovascular disease, peripheral artery disease, and heart failure) regardless of whether they ever develop kidney failure.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

LUTS (Lower Urinary Tract Symptoms) includes:

  1. Irritative voiding symptoms: Increase frequency of urination, urgency to pass urine, urine incontinence (urinary leak with urgency)


  2. Obstructive voiding symptoms: Hesitancy (delay in starting urination), decreased force of urinary stream, intermittency, post void dribbling


Lab test (Dr Navin Dang)

Lab diagnosis of rheumatoid arthritis is based on clinical evaluation with lab investigations of CBC with ESR, CRP, RA factor and anti CCP.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Oxcarbazepine 150/300/600mg Tablet (Addl. Indication)

Treatment of generalized tonic-clonic seizures in adults and children


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Advertising in eMedinewS

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

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second eMedinewS–revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited.


A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17-18, 2010.

Co-organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2pm onwards) and Sunday 18th April (7am-4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. Voluntary contributions welcome.

For booking e-mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com 

Stroke Update Workshop for GPs

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Thanx sir for the daily efforts for sparing ur valuable time to publish daily medical newspaper. Heartiest congrats again for recognition of ur medical service excellence in the shape of Padma Shri. I’m proud to be ur disciple. In relation to news, i would like to comment that v need practice/ execution of the laws, not new laws or court order to curtail illegal practice. In fact its dismal of our system of law that a registered physician has many laws but ‘jhola chhaap’ can b booked for only forgery. Wish u nd ur family a very happy holi. Chao for now. Enjoy, have a great time: Dr. Farahim Chaudhary, Jeddah, Saudi Arabia

  2. Kindly visit http://memigindia.blogspot.com/search?updated–min=2010–01–01T00%3A00%3A00–08%3A00–updated–max=2011–01–01T00%3A00%3A00–08%3A00 & max–results=6 for latest happenings in the field of emergency medicine be it the ongoing Master’s training programme in Emergency Medicine in India, new guidelines, or the motivation factors of emergency physicians practicing in India and worldwide. This blog is running successfully for nearly a year and covers the beauty of this infant specialty of emergency medicine. Happy blogging: Dr Vivek Chhabra

  3. Respected Sir: Emedinews is an amazing effort by you....I thank you for thinking so deeply for future of medicine…I wish to enroll for stress management workshop. I stay in Dehradun nd so need lodging nd food also...would b grateful to u if room can b booked for me. Thank you sir. Warm Regards: Dr. Nitin Chawla