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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; 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

  Editorial ...

5th October 2010, Tuesday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Alternate Therapy for Poorly Controlled Asthma

Doctors usually recommend that adults whose asthma is poorly controlled by low doses of inhaled corticosteroids either increase their inhaled corticosteroids or supplement them with long–acting beta agonists. Neither solution is ideal. Higher doses of corticosteroids do not improve symptoms for all patients and can have significant side effects. The safety of long–acting beta agonists has come under serious scrutiny recently.

A research team led by Dr. Stephen Peters of the Wake Forest University Baptist Medical Center set out to test whether anticholinergic therapy could provide an effective alternative. Anticholinergic drugs help relax the airways by blocking a part of the nervous system that signals airway muscles to contract. Researchers have been exploring anticholinergic therapies in asthma, but this is the first study to test the addition of an anticholinergic inhaler to low–dose inhaled corticosteroids.

The researchers enrolled 210 adults whose asthma was not well–controlled with low doses of inhaled corticosteroids. They compared 3 treatments: doubling the dose of corticosteroids, supplementing the low–dose corticosteroids with a long–acting beta agonist (salmeterol) and supplementing low–dose corticosteroids with a long–acting anticholinergic drug (tiotropium bromide). The participants received each treatment for a 14–week period, followed by a 2–week "washout" period. The study was conducted at multiple clinical centers around the nation by the Asthma Clinical Research Network, which is supported by NIH’s National Heart, Lung and Blood Institute (NHLBI).

The study was published in the September 19, 2010, issue of the New England Journal of Medicine. The scientists found that adding tiotropium bromide to low doses of inhaled corticosteroids is as effective at controlling asthma as adding salmeterol. Both are more effective than doubling inhaled corticosteroids alone.

Tiotropium bromide improved patients’ day–to–day lung function. It also reduced the number of "asthma control days," when they had to use their albuterol inhalers. Extrapolating from the treatment period, the researchers calculated that the patients had an average of 77 asthma control days per year when the trial began. Doubling corticosteroids gave them an average of another 19 symptom–free days. Adding tiotropium to low-dose corticosteroids gave them another 48.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Yoga Diwas 2010

Bharatiya Yog Sansthan, Ramesh Nagar, Delhi observed Gandhi Jayanti (2nd October) as Yog Diwas. Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal was the chief guest on the occasion.
In the photo: Mr Anil Lamba and Mr NL Grover.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Nocturnal leg cramps

A systematic review of prospective trials identified limited data to support the use of several agents, including calcium channel blockers and vitamin B complex, in the treatment of nocturnal leg cramps.

(Reference: Katzberg HD, et al. Assessment: Symptomatic treatment for muscle cramps (an evidence–based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;74:691).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

To All State Presidents & Secretaries, CWC Members & Central Council Members

Dear Sir, You are all aware of the proposal of the Union Ministry of Health & Family Welfare to start a new course called the BRMS (Bachelor of Rural Medicine & Surgery) to serve the rural population exclusively. However when this proposal was discussed in the Central Council (Supreme Governing Body) of the National Indian Medical Association at Hyderabad on 27 December 2009 the members of IMA, Kerala State Branch had vehemently opposed it. We managed to convince the members who attended the meeting regarding the disservice this course would be doing to the rural population in particular and to the nation in general. The proposal of starting such a course was rejected and a resolution against this proposal was passed unanimously by the Central Council of the National IMA. It is not because IMA, Kerala State Branch was not concerned about the rural population. It was only because we felt that dilution of the basic degree was not the solution. Within a week IMA, Kerala State branch prepared a draft highlighting the various pitfalls of this BRMS course. The Draft also gave various suggestions to tide over the problems in the health sector being faced by the rural population of India. As a mark of protest a black day was observed on 20th January 2010 when doctors through out the state wore black badges during the time of work.

IMA, Kerala State Branch IMA organized a peaceful Dharna in front of Rajbhavan, Thiruvananthapuram on 27th January 2010 (27. 01. 2010) to observe the protest day against the move of Government of India to start the BRMS course. More than 5000 doctors and medical students participated in the dharna. We then submitted a Memorandum to His Excellency the Governor of Kerala on the said date after the Dharna. When MCI held a meeting of the Deans of Medical Colleges & Vice Chancellors of Medical Universities and Health Secretaries of State on February 4th at India Habitat Centre, New Delhi, a huge contingent of more than 150 doctors and medical student held a silent dharna outside the venue despite being threatened of imprisonment.

Intensive political lobbying was done where we met the Union Defence Minister Shri A.K.Antony, Union Minister of State for Home Shri Mullapally Ramachandran, M.Ps like  Shri P.C.Chacko, Shri M.K.Raghavan, Shri P.J.Kurien, Shri Kodikunnil Suresh, Shri Sasi Tharoor, Shri Arun Jaitley. Shri P.C.Chacko M.P. took the initiative and helped the leaders from IMA, Kerala State to discuss the BRMS issue with several MPs belonging to Parliament Committee on Health & Family Welfare. They promised to take up the matter earnestly and see that this retrograde proposal is not implemented. Shri P.C. Chacko followed up the matter and even raised his concerns against this proposal in the floor of the parliament. We also initiated the process of fighting the issue legally by utilizing the services of a very efficient and senior lawyer in Delhi. We motivated the students of Kerala & other states and formed an All India Medicos Association. Our senior leaders visited various states to motivate the leaders of other states against BRMS. Unfortunately the role played by the National IMA was lukewarm. They did not show the aggressiveness and enthusiasm that was required to stop such a retrograde proposal. They have no significant actions to showcase their efforts.

However the sincere & dedicated efforts of IMA, KSB were vindicated. Thanks to the sustained and sincere efforts of Shri P.C.Chacko M.P the members of the Parliamentary Committee of Health & Family Welfare met the Honorable Prime Minister of India Shri Manmohan Singh and Chairperson of the United Progressive Alliance & National Advisory Council Mrs Sonia Gandhi and apprised them about the pitfalls of this ill conceived & retrograde proposal. As a result of this the Honorable Prime Minister of India Shri Manmohan Singh has informed the Union Ministry of Health & Family Welfare to stop all further proceedings on this proposal and keep it in abeyance. This is definitely a big achievement which IMA, Kerala State can be proud of. However we cannot remain complacent and have a long way to go. IMA, Kerala State requests all the members and leaders of IMA to rise to the occasion and take up this matter earnestly in your respective State Branches and at National IMA & see that this retrograde course is never implemented.
With warm regards and great expectations of a positive response Jai Hind !  Jai IMA !

Dr.Srikumar Vasudevan                           Dr. J.Rajagopalan Nair
President, IMA,Kerala State                     Secretary,IMA,Kerala State

  International News

(Dr Monica and Brahm Vasudev)

Hologic Inc.’s three–dimensional mammogram device deemed safe by FDA panel

Hologic Inc.’s three–dimensional mammogram device is safe and improves breast–cancer detection when used in combination with conventional mammography.

FDA approves Allergan’s Ozurdex implant for treatment of uveitis

Allergan Inc. announced that its implant Ozurdex received US regulatory approval for a new use in treating eye inflammation.

FDA approves Bayer HealthCare’s new oral contraceptive

FDA approved an oral contraceptive Friday from Bayer HealthCare Pharmaceuticals Inc. that includes a folate supplement.

Insulin resistance may promote early pathological changes in Alzheimer’s, says study

According to a new study following 135 Japanese subjects for at least 10 years leading up to their deaths, researchers found that those who were more resistant to insulin during their lives were more likely to have the amyloid plaques characteristic of Alzheimer’s in their brains when they died.

  Hepatology Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta Medicity

How do you approach a case of neonatal cholestasis?

Subsequent investigations

If the baby is sick, tests are directed towards infective and metabolic causes, however simultaneously one must investigate to rule out EHBA (extrahepatic biliary atresia). Blood tests
  • TORCH, VDRL, Hepatitis B/C, HIV
  • T4, TSH
  • Serum cortisol
  • α1 AT levels and phenotype
  • Galactose 1 phosphate Uridyl transferase (to rule out galactosemia)
  • Urinary succinyl acetone (to rule out tyrosinemia)
  • Cholesterol, triglycerides
  • Serum iron and ferritin levels (to rule out neonatal hemochromatosis)
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What if IVF fails the first time? How many times will I have to undergo the same procedure?

You can go through IVF as many times as you wish, but we advise up to five cycles at the most.

Does one need to get admitted in the IVF process?

A patient undergoing IVF does not require admission. However, one should visit the center 3–5 times during monitoring cycle. On the day of egg collection, the patient would need to fast for 6 hours and come to clinic (the procedure takes about half an hour). Patients can go home after the effect of anesthesia wears off, which takes about 2–3 hours. The next scheduled visit is after 2–3 days for the embryo transfer, which again takes about half an hour and patients are free to go home after resting for one hour.

  Eye Update: Question of the Day

Should physical activity or contact sports be discouraged if one has a minus number? (Dr Quresh Maskati)

No. The child should be encouraged to grow up normally and in fact encouraged to take up physical activity. Most children who are shortsighted end up preferring indoor activities and books rather than outdoor sports. It is up to the parents to push the child to explore the world outside the house with their glasses on. It is true that myopes are more prone to retinal detachment. However, an annual retinal examination by your eye doctor will reveal any thinned out areas of the retina requiring preventive treatment. If none exist, no restrictions need apply in spite of there being a "high" minus number.

  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What was the Dr. Sam Sheppard Murder Case?

American Trial of the Century in 1954

A brief history of the murder: The family slept after casual dinner and the wife was found dead in the morning. The preliminary police investigation of the crime scene put Sam Sheppard under suspicion. Sheppard’s account of events made little sense. The neatly pulled out desk drawers were not what to be expected from a robbery. There did not appear to have been a forced entry. Police conducted an investigation on the assumption that the crime was a domestic homicide. So, there not enough effort made to recover fingerprints and blood evidence that might have been expected in a neutral investigation.
The autopsy showed Marilyn to have been pregnant with a 4–month–old male fetus. Her body was found lying face up in the bed, with her face turned toward the door. Marilyn’s face was all but unrecognizable. Over twenty curved gashes cut deeply into her face and scalp. Blood outlined her body, staining the cover and pillow. On the walls and closet doors were dozens of spots of blood. Her pajama top was pulled up, baring her breasts. Her pajama bottom had been removed from one leg, leaving her pubis exposed. Her legs had been pulled beneath the wooden bar and the foot of her bed. The autopsy determined her time of death at "about 4:30 A.M. A reasonable interpretation of the state’s evidence pointed the finger of guilt at Sam Sheppard."
That the evidences show that "this defendant and Marilyn were quarreling about the activities of Dr. Sam Sheppard with other women" and that "that is the reason she was killed. "And the forensic evidences collected in this case are suggestive of the same. Judge Blythin read the verdict form: "We find the defendant guilty of murder in the second degree." Blythin sentenced Sheppard to life, with his first eligibility for parole in ten years.

  Medi Finance Update


RBI bond investment is low risk with low returns, but safe. The 6.5% Govt. Bonds, 2003  is good investment. The interest on such bonds is tax–free.

  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combinations of Iron with Strychnine, Arsenic and Yohimbine

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Only tissue diagnosis is conclusive. Where tissue diagnosis is not possible, clinical correlation along with radiology findings is mandatory.

MTNL Perfect Health Mela 2010
IMA election
  IJCP Special

Dr Good Dr Bad

Situation: A 70–year–old male needed mitral valve replacement.
Dr Bad: Go for mechanical valve.
Dr Good: Go for Bioprosthetic valve.
Lesson: A bioprosthetic valve can be preferred for a patient more than 65 years of age.

Make Sure

Situation: A patient with 3 hour duration of chest pain developed acute cardiac arrest.
Reaction: Oh my God! Why was water–soluble aspirin not given at the time of chest pain?
Lesson: Make sure that all patients with suspected MI are given water–soluble aspirin to reduce chances of death.

SMS of the Day (Dr Chandresh Jardosh)

How to gain, how to keep, and how to recover happiness is in fact for most men at all times the secret motive for all they do. William James

  Mind Teaser

Read this…………………

Math The

Answer for yesterday’s Mind Teaser: "Who’s in "charge".

Correct answers received from: Dr Jayashree B Keshav, Dr Rawat Purushottam Singh, Dr Chandresh Jardosh, Dr Sudha Nayyar, Dr. Susheela Gupta, Dr. K. Raju, Dr. Adityarattan, Dr Muthumperumal Thirumalpillai, Dr.K.P.Rajalakshmi, Dr Virender Prakash Gautam.

Answer for 3rd October Mind Teaser is: "Three Musketeers"

Correct answers received from: Dr Antara Sablok

Correct answer for 2nd October eQuiz received from: Dr Varesh Nagrath

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr Chandresh Jardosh)
Wrong email id

A man checked into a hotel. There was a computer in his room, So he decided to send an e–mail to his wife. However, he accidentally typed a wrong e-mail address, and without realizing his error, he sent the e–mail.
Meanwhile… Somewhere in Houston, a widow had just returned from her husband’s funeral. The widow decided to check her e–mail, expecting condolence messages from relatives and friends.
After reading the first message, she fainted. The widow’s son rushed into the room, found his mother on the floor and saw the computer screen which read:

To: My Loving Wife
Subject: I’ve Reached
Date: 23 July 2008

I know you’re surprised to hear from me.
They have computers here, and we are allowed to send e–mails to loved ones.
I’ve just reached and have been checked in.
I see that everything has been prepared for your arrival tomorrow.
Looking forward to seeing you TOMORROW!

You are an Indian if you (Anuj Goel)
You recycle Wedding Gifts, Birthday Gifts and Anniversary Gifts.

  An Inspirational Story

Only One Childhood
I stopped to watch my little girl busy playing in her room. In one hand was a plastic phone; in the other a toy broom. I listened as she was speaking to her make–believe little friend and I’ll never forget the words she said, even though it was pretend. She said, "Suzie’s in the corner cuz she’s not been very good. She didn’t listen to a word I said or do the things she should." In the corner I saw her baby doll all dressed in lace and pink. It was obvious she’d been put there to sit alone and think. My daughter continued her "conversation," as I sat down on the floor. She said, "I’m all fed up, I just don’t know what to do with her anymore? She whines whenever I have to work and wants to play games, too. She never lets me do the things that I just have to do?

She tries to help me with the dishes, but her arms just cannot reach… And she doesn’t know how to fold towels. I don’t have the time to teach. I have a lot of work to do and a big house to keep clean. I don’t have the time to sit and play –– don’t you know what I mean?" And that day I thought a lot about making some changes in my life; as I listened to her innocent words that cut me like a knife. I hadn’t been paying enough attention to what I hold most dear. I’d been caught up in responsibilities that increased throughout the year.

But now my attitude has changed, because, in my heart, I realize… I’ve seen the world in a different light through my little darling's eyes. So, let the cobwebs have the corners and the dust bunnies rule the floor, I’m not going to worry about keeping up with them anymore. I’m going to fill the house with memories of a child and her mother… For we are granted only one childhood, and we will never get another.

  Readers Responses
  1. Plz accept my congrats for this laudable venture. Dr (Prof) Suraj Gupte.
  2. Well done Dr Agarwal. You have been giving meaningful explanations. I liked the one on Kush grass very much. I am also a firm believer in that whatever our ancestors did was with a lot of purpose and good intent. Unfortunately people who are ignorant of all this give a religious meaning to it and misinterpret facts. I recently found excellent results for curing acute rhinitis (common cold) with Lavanansh and Amrita Balli (Guduchi). My own brother who is an ENT Surgeon in the UK was stunned to see that he could get rid of the cold in one day after drinking Kashayam made of Lavanansh + Amrita Balli. There is a lot of truth in what our ancestors did. Prof .C V Raghuveer, MD, DCP, FICP (Path).
  3. Simply great. Tussi great ho Sir. Just brilliant. It was ignorance on my part to make such comments.  Vivek, Varanasi.
  Public Forum

(Press Release for use by the newspapers)

Divya Jyoti – Nursing Festival at the MTNL Perfect Health Mela

More than 1500 nurses from various hospitals, nursing schools and colleges will be participating in the day-long event ‘Divya Jyoti’ on Friday 29th October, said Padma Shri and Dr BC Roy National awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Ms Rekha Papola and Dr Soni Verma coordinators of the event said that nurses are the backbone of the society. Defining the word NURSE they said that Nurse is a person who is Noble, Understanding, Response, Simple and Efficient.

The event will include competitions like skit, painting, poster & slogan making, model making, etc which will be judged by eminent judges. All nursing schools and colleges of the city will be participating in the event. Nurses would also provide free counseling and checkups to the visitors at large.

  Forthcoming Events

CPLD 2010: Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi. 

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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