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Dr KK Aggarwal

From the Desk of Editor in Chief
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; 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


5th June, 2010, Saturday (Issue is ahead of print)

STOP PRESS: High court Judgment on Dr Ketan Desai' s Bail Being published below, see after the public forum column.

Increases in Waist Circumference and Weight May Predict Incident Diabetes

Dear Colleague

Increases in waist circumference and weight may predict incident diabetes, according to the results of a study reported online May 18 in Diabetes Care.
Dr Alain Gautier, from Center Hospitalier Universitaire de Rennes in France, from the Data from an Epidemiological Study on the Insulin Resistance syndrome (D.E.S.I.R.) Study Group reported that patients who had impaired fasting glucose (IFG) were at high risk for type 2 diabetes. Waist circumference and visceral adiposity are established risk factors for type 2 diabetes. But, it is only now that the impact of an increase in waist circumference (WC velocity) among individuals with IFG at baseline has been studies, especially in individuals who are not overweight or obese at baseline.

Using the D.E.S.I.R. cohort, the 9–year incidence of diabetes in 979 men and women with baseline IFG were investigated. Increases in both waist circumference and weight were significantly associated with diabetes incidence even after adjustment for risk factors at baseline. Standardized odds ratios (ORs) were 1.79 for waist circumference {95% confidence interval (CI), 1.45 – 2.21} and 1.86 for weight (95% CI, 1.51 – 2.30). The effect of increase in waist circumference was greater in patients with a BMI of less than 25 kg/mg at baseline (OR, 2.40) than patients who had a BMI of 25 kg/mg or more at baseline (OR, 1.66).

Hence, it becomes important to monitor and prevent increases in waist circumference, particularly in those individuals with IFG, who have a BMI less than 25 kg/m².

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature

Flagging off the World Environment Day, June 5, 2010

A special tableau made by Heart Care Foundation of India supported by Department of Environment, Government of Delhi, was flagged off on the eve of World Environment Day.

Left to Right : Shri Oris Syiem Myriaw -Member Tribal Commission, Govt.of of India; Nalini -Eminent Kathak Dancer; Acharya Dr Sadana ji Maharaj; Kamalini -Eminent Kathak Dancer; Shri SS Agrawal- Director Dipsar; Dr Anil Kumar -Director Environment; Shri Dharmendra- Secretary Environment; Padma Shri and Dr B C Roy Dr KK Aggarwal- President Heart Care Foundation Of India; Dr Sudesh Ratan

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New FDA Drug Update

Pazopanib

An orally active multitargeted tyrosine kinase inhibitor, pazopanib, was approved by US FDA for treatment of advanced renal cell carcinoma. Approval was largely based on the results of a phase III trial in which pazopanib significantly increased progression–free survival compared to placebo.

References

  1. Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: Results of a randomized phase III trial. J Clin Oncol 2010;28:1061-8.

Mnemonics of the Day (Dr Prachi)

Wound healing: factors delaying wound healing – DID NOT HEAL

Drugs
Infection/ Icterus/ Ischemia
Diabetes

Nutrition
Oxygen (hypoxia)
Toxins

Hypothermia/ Hyperthermia
EtOH (ethyl alcohol)
Acidosis
Local anesthetics

News and Views

FDA panel backs tesamorelin to treat HIV–associated lipodystrophy

FDA’s Endocrinologic and Metabolic Drugs Advisory Committee has unanimously supported the proposed drug, tesamorelin (Egrifta) as treatment for HIV–associated lipodystrophy. Egrifta is manufactured by Theratechnologies Inc.

CDC says HPV vaccine is safe, effective in men

Confirming its provisional recommendation from 2009, the CDC has said that the HPV vaccine (Gardasil) against human papillomavirus infection is both safe and effective in males in preventing genital warts. FDA had approved the HPV vaccine in 2006 in females aged 9 to 26 years as a preventive measure for cervical cancer and genital warts. Later, it was recommended to be a part of routine vaccination for all girls 11 to 12 years old by the CDC’s Advisory Committee on Immunization Practices (ACIP). Though in 2009, ACIP added males to the population who could benefit from the vaccine, it did not recommend making it a part of routine vaccination.

Abnormalities in signaling pathways in diabetic nephropathy
(Dr G M Singh)

Over the years, the knowledge about the signaling pathways that lead to diabetic nephropathy (DN) has increased considerably. The plethora of signaling abnormalities in DN result in the clinical and pathologic hallmarks of DN, namely progressive albuminuria followed by a gradual decline in glomerular filtration rate leading to kidney failure, and accompanied by podocyte loss, progressive glomerular sclerosis and, ultimately, progressive tubulointerstitial fibrosis. (Expert Rev Endocrinol Metab 2010;5(1):51–64)

Surgical anemia affects the action of β–blockers (Dr G M Singh)

A study published in the January issue of Anesthesiology reported that patients undergoing non–cardiac surgery and who develop acute surgical anemia have greater chances of suffering major cardiac complications and mortality if they receive perioperative β–blockers. Data from 4,387 patients who underwent major non–cardiac surgeries was analyzed. β–blocked patients were more prone to major adverse cardiac events (relative risk, 2.38). However, β-blockers were only associated with higher risk when patients had a decrease in hemoglobin of greater than 35 percent.

Conference Calendar

FESS 2010
Image Guided Endoscopic Sinus Surgery Live Surgical Workshop cum Hands–on Cadaver Dissection Workshop on FESS
Date: June 5–6, 2010
Venue: Department of E.N.T., NEIGRIHMS, East Khasi Hills, Meghalaya

Quote of the day (McMahon Pharmacy Practice News, November 2009)

Height of kindness

One afternoon a lawyer was riding in his limousine when he saw two men along the roadside eating grass.

Disturbed, he ordered his driver to stop and he got out to investigate. He asked one man, "Why are you eating grass?"
"We don’t have any money for food," the poor man replied. "We have to eat grass.""Well, then, you can come with me to my house and I’ll feed you," the lawyer said.

"But sir, I have a wife and two children with me. They are over there, under that tree.""Bring them along," the lawyer replied. Turning to the other poor man he stated,"You come with us, also."

The second man, in a pitiful voice, then said, "But sir, I also have a wife and SIX children with me!""Bring them all, as well," the lawyer answered.

They all entered the car, which was no easy task, even for a car as large as the limousine was.

Once underway, one of the poor fellows turned to the lawyer and said, "Sir, you are too kind. Thank you for taking all of us with you."

The lawyer replied, "Glad to do it. You’ll really love my place…… The grass is almost a foot high!"

Question of the Day

What is the best indicator of growth?

Weight gain or height gain over a period of time is velocity and it is a better indicator of growth. It reflects the effectiveness of any intervention, namely nutritional supplementation, stimulation, growth hormone therapy.
1. Weight velocity is 6 kg in the first year.
2. 2kg/year in a pre–schooler.
3. 3 kg/year till puberty in school–going child 1. Height velocity is 25 cm in the first year; 12.5 cm in the second year and thereafter.
4. It is 6 cm/year till puberty.

Liver Fact

In acute muscle injury, SGOT/SGPT ratio is generally greater than 3 on the first day.

Women Safety Tips

As women, we are always trying to be sympathetic: STOP, It may get you raped, or killed. Ted Bundy, the serial killer, was a good–looking, well educated man, who ALWAYS played on the sympathies of unsuspecting women.
He walked with a cane, or a limp, and often asked ‘for help’ into his vehicle or with his vehicle, which is when he abducted his next victim.

7 Myths About Bipolar Disorder (4)

Bipolar disorder is more common in women than men.

eMedinewS Try this it Works

Beware of bismuth subsalicylate and aspirin

Patients who use bismuth subsalicylate therapy receive almost 2 g of salicylates from the usual dosage of 8 tablets per day. Therefore, they should be cautioned to decrease their use of aspirin or other salicylates while taking these tablets.

Dr Good Dr Bad

Situation: A type 2 diabetic came for lung functions advice.
Dr Bad: Get PFT done.
Dr Good: Get PFT with diffusion studies done.
Lesson: Impairment of pulmonary diffusion capacity for carbon monoxide was common in T2DM Asian Indian patients having microangiopathy. A significant reduction of pulmonary diffusion capacity for carbon monoxide (DLco) was observed in patients with T2DM with any or a combination of microangiopathy(ies) such as retinopathy, nephropathy, and peripheral neuropathy. (Indian J Med Res 2004;119(2):66–71.)

Make Sure

Situation: A child with sore throat and the large lymph nodes developed rheumatoid fever.
Reaction: Oh my God! Why was an antibiotic not given in time?
Lesson: Make sure that all children with sore throat and enlarged lymph nodes are given antibiotics as such sore throats are streptococcal unless proved otherwise.

IMANDB Joke of the Day (Anuj Goyal)

COURTESY

The witness was obviously a rustic and quite new to the ways of a court–room. So, the judge directed him: "Speak to the jury, sir–the men sitting behind you on the benches."

The witness turned, bowed clumsily and said: "Good–morning, gentlemen."

Formulae in Clinical Practice

Calculation of lean body mass in men

Formula: Lean body weight (men) = {1.10 × weight (kg)} – 128 {weight2/(100 × height in m2)}

Milestones in Orthopedics

1805–1878: Mathysen was a Dutch military surgeon who in 1851, invented the plaster of Paris (POP) bandage which was to become so important to Orthopedic practice. To this day, a POP cast is the mainstay of fracture immobilization.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Hepatitis E Antibody, IgG (Anti–HEV, IgG), Serum

HEV–infected patients develop symptoms of hepatitis with appearance of anti–HEV IgM antibody in serum, followed by detectable anti–HEV IgG antibody within a few days. Anti–HEV IgM remains positive for up to 6 months after onset of symptoms, while anti–HEV IgG levels usually persist for years after infection. Anti–HEV IgG is the serologic marker of choice for diagnosis of past HEV infection.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Levosulpiride ER Tablet 100/150/200mg

For the treatment of depression and schizophrenia in adults

27.10.2009

 

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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 .

 

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Public Forum (Press Release for use by the newspapers)

Small weight gain: a risk to kidneys

New Delhi, In healthy men of normal weight, relatively small increases in weight raise the risk of chronic kidney disease (CKD), said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Quoting a study in the Journal of the American Society of Nephrology, Dr Aggarwal said that CKD should be added to the list of conditions that are associated with weight gain, including diabetes and high blood pressure. Obesity is a known risk factor for CKD, but weight gain in normal–weight individuals without high blood pressure or diabetes is now shown to be an added risk factor.

The experts followed 8792 healthy men aged 30 to 59 years with no known risk factors for CKD between 2002 and 2007. The prevalence of obesity was about 33 percent. The researchers observed a U–shaped association between changes in weight categories among normal–weight and overweight subjects and the development of CKD. Men who lost or gained a lot of weight (more than 0.75 kilograms, or 1.7 pounds, per year) had the highest risk of developing CKD. Increased risk was seen among men with even small weight changes. The lowest risk observed was among those who gained or lost as little as 0.25 kilograms, or 0.6 pounds, per year.

The findings suggest that weight gain within ‘the normal’ weight range is clearly one of the risk factors in developing CKD, and initial low body mass index does not counteract the deleterious effect of weight gain.

Avoidance of weight gain, even among lean individuals, is important to reduce the risk for this disease.

Do not ignore breakfast.

Bail Application No. 839/2010 and Crl. M.A. No.718/2010

High Court Denies Bail to Dr Ketan Desai

This is a petition for grant of regular bail in case RC No. 02(A)/10/ACU-IX/CBI dated 22nd April, 2010 under Section 7, 8, 11, 13 (2) read with 13 (1) (d) of the Prevention of Corruption Act, 1988 (hereinafter „the PC Act‟).

As per Bail Application No. 839/2010, the prosecution this case was registered on the allegations that Dr. Ketan Desai, President, Medical Council of India (MCI) entered into a criminal conspiracy with Shri J.P. Singh with an intention to obtain bribe for grant of permission to Gyan Sagar Medical College, Patiala. The concerned management of this medical college became a party to this conspiracy by agreeing to pay the bribe in order to get certain shortcomings in the infrastructure overlooked by the MCI. The CBI received a source information on the basis of which enquiry was conducted, during which the relevant mobile phones were intercepted.

It is contended that after registration of the case a team was deployed at the residence of Shri J.P. Singh at D-6/13, Vasant Vihar, New Delhi to intercept Dr. Kamaljeet Singh who was coming to deliver the bribe amount of Rs. 2 Crore. At about 12.50 hrs. on 22nd April, 2010, Dr. Kamaljeet Singh while coming out of the house of Shri J.P. Singh was challenged and interrogated and on his disclosure, Rs. 2 Crore was recovered from the office located at the ground floor of the residential premises of Shri J.P. Singh at D-6/13, Vasant Vihar, New Delhi.

Learned counsel for the CBI states that the present is a case of larger conspiracy wherein the Petitioner, former President, Medical Council of India (MCI) was not only passing on prior information to Shri J.P. Singh pertaining to the schedule of inspection by MCI but also ensured that favourable report would be given by the Inspection Team of MCI. According to learned counsel, despite Bail Application No. 839/2010, the fact that the Gyan Sagar Medical College was lacking in certain requisite infrastructure which could not have been completed within such a short duration, the Petitioner and Shri J.P. Singh helped the Institute to get favourable report from MCI in lieu of a consideration of an amount of Rs. 2 crores to be delivered through Shri J.P. Singh to the Petitioner. In this regard statement of a witness recorded under Sec. 164 Cr.P.C has been relied upon.

Learned counsel for the CBI has also produced the transcript of the conversations between the parties. The transcript of the conversations show continuous interaction between Dr. Ketan Desai, Sukhwinder Singh, Jitender Pal Singh, Kamaljeet Singh, K.A. Paul and Nirmaljeet Singh Bhango and the conversations are co-relatable to the dates on which the events took place. The conversation amongst the accused persons reflect the motive, demand of bribe and the modus operandi for the favours shown to the Gyan Sagar Medical College and Hospital, Patiala.

It is submitted that two accused persons, that is, Nirmaljeet Singh Bhango and K.A. Paul are still absconding. It is submitted by learned counsel for the CBI that the Petitioner was holding a very sensitive position and the compromise thereon was affecting the medical education in the country which had far-reaching consequences not only on the educational standard of the doctors but also the patients. It is submitted that the investigations are prima facie leading to the fact that the Petitioner and Shri J.P. Singh are involved in such an incident relating to one more medical college.

It is stated that since the Petitioner was holding a sensitive position and was a highly influential person, initially people were not coming forward to complain against him. Even in the present case the complainant was not ready to divulge his identity and thus, the enquiry started on source information. It is for this reason, it was put on the official website of the CBI, that in case anybody has any complaint against the petitioner/MCI, the same may be informed to the CBI. It is thereafter that the complaints are pouring in and till now approximately 225 complaints have been received.

It is stated that another case of disproportionate assets has also been registered against Dr. Ketan Desai. According to her, the Petitioner is an influential person and there is every likelihood of his tampering of evidence in case he is released on bail.

Learned counsel for the Petitioner contends that the permission to Gyan Sagar Medical College was granted after completing all the necessary formalities. According to learned counsel a Committee was set up by the Central Govt to look into the issue of grant of approval to the Gyan Sagar Medical College which also found no irregularity in it. Learned counsel states that as per the search list, the investigating agency itself was not aware whose money it was. Moreover, the amount of Rs.2 crore in the search list at item No.50 has been added subsequently after the witnesses had signed the same.

Learned counsel places reliance on Professor K. Narayan Rao vs. CBI, 2009 (4) JCC 2551; Anurag Vardhan vs. CBI, 105 (2003) DLT 594. It is contended that the petitioner has already spent nearly 44 days and in any case investigation has to be completed with a period of 60 days and thus, the investigation having nearly reached completion, there is no likelihood of the petitioner‟s interfering with the investigation. It is contended that the statement of Lakhvinder Singh is not reliable, as the search list shows that only one person came out from the car and thus either it could be that person or the driver Lakhvinder Singh. It is contended by learned counsel for the Petitioner that the Petitioner is no longer the President of MCI and has also been suspended as a Professor and thus there is no likelihood of his committing such an offence in future. There is no recovery effected from the Petitioner which fact has been admitted by the CBI in its reply filed before this Court. It is contended that there is no material to show that the Petitioner had shown favour to the Gyan Sagar Medical College and Hospital for grant of approval.

It is stated that the transcript if any are in the possession of CBI which the Petitioner cannot tamper with and thus no useful purpose will be served by keeping him in custody. The Petitioner‟s mother is ailing and in this regard he has filed an application for interim bail as well. The Petitioner is the only son and thus, is required to look after his mother. It is stated that the Petitioner is also suffering from “obstructive sleep apneya” and thus requires constant medical attention.

Learned counsel for the CBI with regard to the aliment of the mother, states that the mother was operated on 11th November, 2009 and there is no apparent problem at the moment. Moreover, the treatment which she had undergone from Dr. Gandhi for her Psycotic ailment was 3-4 years back. It is stated that the wife of the Petitioner is a doctor and running a full-fledged nursing home. Thus, requisite medical facilities are available to the mother of the Petitioner. Qua the Petitioner, it is stated that learned Trial Court has directed that the required breathing aid, that is, nasal CPAP be provided to the Petitioner which requires no regulation and the Petitioner for his ailment of Hypertension is on regular medication. 11.

I have heard learned counsel for the parties. I have also perused the statements of the witnesses recorded under Section 161 and the transcript of the conversations between the parties. The transcript corroborates the sequence of events as to how first deficiencies were pointed out and then a favourable report was given, after getting the inspection done by a particular team, who acted on the behest of the present Petitioner. From the material on record, prima facie, a case of conspiracy under Sections 7, 8, 11, 13 (2) read with 13 (1) (d) of the PC Act is made out. In the preset petition, the issue for consideration before this Court is whether it is a fit case for grant of bail to the Petitioner.

The Petitioner has been in custody for 44 days. The Petitioner is the main accused in the present case. The present case is not registered on the complaint of an individual but the CBI acted on a source information and thereafter intercepted the conversations of the accused persons leading to a trap being conducted, wherein Rs. 2 Crore, which was to be given to the Petitioner for extending favour, were recovered and thus, on registration of a FIR the Petitioner and the other accused persons were arrested on 22nd April, 2010. The Petitioner was the President of Medical Council of India, a statutory body, responsible for the medical education of the country. The grant of permission for continuing with the medical courses and introducing new courses was in the hands of this statutory authority. Injudicious discretionary exercise affects the quality of education obtained by persons who got medical degrees, thereby affecting the health of patients of the country. It may be noted that in this case also the complainant has not come forward and the Petitioner would have gone scot free but for the reliance on the source information and interception conducted by the CBI. This clearly demonstrates the influence built up by the Petitioner.

I find force in the contention of learned counsel for the CBI that because of the influence of the Petitioner nobody came forward to make complaints against the Petitioner regarding demand of money or for giving approval/permission to colleges without requisite infrastructure. It is for this reason that the CBI had to put on the website, requesting the people to come forward to give complaints against the Petitioner/MCI officials if they had any. The fact that the Petitioner was in custody and on the CBI's assurance number of complaints have been received, which now have reached upto 225 approximately, demonstrates the fact that people are not willing to come forward and complain against the Petitioner due to his influence.

On a specific query being put to learned counsel for the CBI as to whether the said complaints would be investigated in this very FIR or separate FIR would be registered, learned counsel for the CBI states that on these complaints, in case cognizable offences are made out, separate FIRs would be registered. It is also pointed out that one more case under the PC Act for having disproportionate assets has already been registered against the Petitioner and his family members. 13.

Be that as it may in view of the fact that the Petitioner is the main accused and now being in custody, people are coming forward to give complaints which would have to be inquired and thereafter investigated if need arises, I am not inclined to grant bail to the Petitioner at this stage. I am also not inclined to grant bail to the Petitioner on the ground that the Petitioner is suffering from hyper-tension and sleep apnea, in view of the fact that the Petitioner has already been provided with CPAP machine and for hypertension he is on regular medicines. Regarding the mother's ailment, it may be noted that she was hospitalized from 8th February, 2010 to 17th February, 2010 only for evaluation of her neurological problem. As per the medical report it is observed that from 2003 onwards she is a case of progressive dementia with cognitive and behavioural dysfunction and has been advised continuous treatment and care. No ground is made out for release on bail in view of the fact that the Petitioner is the only son who has to look after his mother, as the wife of the Petitioner is a doctor and running a nursing home. Thus, there are sufficient number of doctors to take care of the old ailments of the Petitioner‟s mother, which need no emergent attention. 15. The petition and Crl. M.A. No. 718/2010 are stand dismissed.

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5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

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Readers Responses

  1. Congratulations for useful information daily. In case of chronic diarrhea do not forget to order for HIV. Prof. Mam Chandra. Retd. HOD of Medicine and Gastro., KGMU, Lko.

  2. Endoscopic surgery for chronic sinusitis may significantly improve quality of life: Up to 16% of the US population has chronic rhinosinusitis, according to a report in the May 2004 issue of the Annals of Otology, Rhinology & Laryngology, Supplement. Patients with poor response to medical treatment might need endoscopic sinus surgery: Dr G M Singh